| Doctor Name: | MS. CAROL CORINNE BRADFORD |
| NPI Number: | 1962534891 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMP |
| License Number: | 024201MA00015161 |
| Business Practice Address: | 106 E 3rd St Suite 5a Moscow, ID - 838432970 |
| Business Phone Number: | 2088835856 |
| Business Fax Number: | 2082895211 |
| Mailing Address: | Po Box 89, KENDRICK |
| State: | ID |
| Postal Code: | 835370089 |
| Phone Number: | 2088835856 |
| Fax Number: | 2082895211 |
| NPI Enumeration Date: | 03/09/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225700000X |
| License Number: | 024201MA00015161 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| 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. |