MEDICARE: SUSAN MARY SHERMAN LMP

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	MA 00010494	WA

General Provider Information

NPI Number	:	1093968281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MARY SHERMAN LMP

Provider Business Mailing Address
First Line	:	771 OLD GARDINER RD
Second Line	:
City	:	SEQUIM
State	:	WA
Zip	:	98382-8701
Country	:	US
Telephone Number	:	360-797-7830
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 1ST ST
Second Line	:	SUITE E
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-4323
Country	:	US
Telephone Number	:	360-301-1645
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2008
Last Update Date	:	10/31/2008

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