Doctor Name: | MS. KARRIE LARAE WILSON |
NPI Number: | 1073761185 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMP |
License Number: | MA60025093 |
Business Practice Address: | 501 Se 172nd Ave Vancouver, WA - 986849542 |
Business Phone Number: | 3608822778 |
Business Fax Number: | 3606041771 |
Mailing Address: | 700 Ne 87th Ave, VANCOUVER |
State: | WA |
Postal Code: | 986641913 |
Phone Number: | 3603971500 |
Fax Number: | 3606041771 |
NPI Enumeration Date: | 09/03/2008 |
NPI Last Update Date: | 12/28/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA60025093 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |