Individual
MRS. MICHELLE L CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3322 W WILLOW KNOLLS DR, SUITE B, PEORIA, IL 61614-8148
(309) 690-3322
Mailing address
1637 W CLAREWOOD AVE, PEORIA, IL 61614-5736
(309) 213-4040
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2980-146
WI
Other
Enumeration date
08/20/2014
Last updated
08/20/2014
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