MEDICARE: LWJH LLC OLYMPIC DAY SPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA00020574	WA
2	225700000X	Massage Therapist	MA00018810	WA
3	225700000X	Massage Therapist	MA00017400	WA
4	225700000X	Massage Therapist	MA00019751	WA
5	225700000X	Massage Therapist	MA00006874	WA

General Provider Information

NPI Number	:	1093872004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LWJH LLC OLYMPIC DAY SPA

Provider Business Mailing Address
First Line	:	PO BOX 2706
Second Line	:
City	:	POULSBO
State	:	WA
Zip	:	98370-2706
Country	:	US
Telephone Number	:	360-697-3767
Fax Number	:

Provider Business Practice Location Address
First Line	:	18820 FRONT ST
Second Line	:
City	:	POULSBO
State	:	WA
Zip	:	98370
Country	:	US
Telephone Number	:	360-697-3767
Fax Number	:

Authorized Official
Title or Position	:	BILLING
Name	:	KATHLEEN CANCEL
Credential	:
Telephone Number	:	360-697-3767

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	08/22/2020

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Directions to “LWJH LLC OLYMPIC DAY SPA ” Practice Location

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