Provider Demographics
NPI:1174244685
Name:SIEBOLD, KARIN (LMBT, CST-D, MLD-C)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:SIEBOLD
Suffix:
Gender:F
Credentials:LMBT, CST-D, MLD-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 ALYSSUM AVE
Mailing Address - Street 2:
Mailing Address - City:CASWELL BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28465-8425
Mailing Address - Country:US
Mailing Address - Phone:910-612-6618
Mailing Address - Fax:
Practice Address - Street 1:420 N HOWE ST
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-3422
Practice Address - Country:US
Practice Address - Phone:910-612-6618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11275225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist