MEDICARE: MS. SUSAN GUTTZEIT 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	MA00009726	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0122607	OTHER	WA	LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1184817751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN GUTTZEIT LMP

Provider Business Mailing Address
First Line	:	909 HARRIS AVE
Second Line	:	SUITE #201H
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-7080
Country	:	US
Telephone Number	:	360-738-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 HARRIS AVE
Second Line	:	SUITE #201H
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-7080
Country	:	US
Telephone Number	:	360-738-9800
Fax Number	:

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

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	08/27/2007

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