MEDICARE: KARISSA ORTMAN LOEWEN LMT

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	MA61581588	WA
2	225700000X	Massage Therapist	MT11021	SD

General Provider Information

NPI Number	:	1134951577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARISSA ORTMAN LOEWEN LMT

Provider Business Mailing Address
First Line	:	1650 LYNDON FARM CT STE 300
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-5005
Country	:	US
Telephone Number	:	813-560-8157
Fax Number	:	812-590-8333

Provider Business Practice Location Address
First Line	:	814 DUPONT ST
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-3103
Country	:	US
Telephone Number	:	360-671-2900
Fax Number	:	360-671-2828

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

Provider Enumeration Date	:	08/15/2024
Last Update Date	:	08/15/2024

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Directions to “ KARISSA ORTMAN LOEWEN LMT” Practice Location

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