Individual
CAROLYN CLARK MATHERNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT LA#7483
Contact information
Practice address
1072 ORMOND BOULEVARD, SUITE#A, DESTREHAN, LA 70047-3631
(985) 307-0977
Mailing address
546 CLAYTON DR, NORCO, LA 70079-2326
(985) 974-0955
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7483
LA
Other
Enumeration date
01/09/2018
Last updated
01/09/2018
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