MEDICARE: WHITNEY MICHELLE BOLING 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	MA60012493	WA

General Provider Information

NPI Number	:	1134382674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY MICHELLE BOLING LMP

Provider Business Mailing Address
First Line	:	418 CARPENTER RD SE
Second Line	:	STE 102
City	:	LACEY
State	:	WA
Zip	:	98503-7905
Country	:	US
Telephone Number	:	360-350-2968
Fax Number	:	360-539-7729

Provider Business Practice Location Address
First Line	:	418 CARPENTER RD SE
Second Line	:	SUITE 102
City	:	LACEY
State	:	WA
Zip	:	98503-7905
Country	:	US
Telephone Number	:	360-350-2968
Fax Number	:	360-539-7729

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

Provider Enumeration Date	:	07/03/2008
Last Update Date	:	10/31/2016

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