Individual
MRS. CARRIE A TAVARES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
9623 32ND ST SE STE 117&118, LAKE STEVENS, WA 98258-5779
(206) 660-8500
(425) 320-4091
Mailing address
6822 279TH ST NW, STANWOOD, WA 98292-6041
(206) 660-8500
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA00012196
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
604525883
LAKESIDE MASSAGE AND WELLNESS STUDIO
WA
Enumeration date
03/15/2017
Last updated
02/19/2020
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