Provider Demographics
NPI:1528430824
Name:ST.CARRELL, KRISTIN (LMP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:ST.CARRELL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 NW THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9412
Mailing Address - Country:US
Mailing Address - Phone:360-990-2186
Mailing Address - Fax:
Practice Address - Street 1:19611 7TH AVE NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7384
Practice Address - Country:US
Practice Address - Phone:360-990-2186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60580725225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist