Provider Demographics
NPI:1992998918
Name:CARMICHAEL, ANGELINE MARIE (LMT)
Entity type:Individual
Prefix:MRS
First Name:ANGELINE
Middle Name:MARIE
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4863
Mailing Address - Country:US
Mailing Address - Phone:573-449-4929
Mailing Address - Fax:
Practice Address - Street 1:810 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4863
Practice Address - Country:US
Practice Address - Phone:573-449-4929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006037661225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist