Individual
MS. CAROL CORINNE BRADFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
106 E 3RD ST, SUITE 5A, MOSCOW, ID 83843-2970
(208) 883-5856
(208) 289-5211
Mailing address
PO BOX 89, KENDRICK, ID 83537-0089
(208) 883-5856
(208) 289-5211
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
024201MA00015161
WA
225700000X
Massage Therapist
Primary
034956-00
ID
Other
Enumeration date
03/09/2007
Last updated
07/08/2007
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