MEDICARE: MS. RUTH IRENE HESSE 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	MA00024934	WA

General Provider Information

NPI Number	:	1245467315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RUTH IRENE HESSE LMP

Provider Business Mailing Address
First Line	:	4314 BAGLEY AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-7627
Country	:	US
Telephone Number	:	206-755-8458
Fax Number	:

Provider Business Practice Location Address
First Line	:	2319 N 45TH ST
Second Line	:	#308
City	:	SEATTLE
State	:	WA
Zip	:	98103-6982
Country	:	US
Telephone Number	:	206-201-1120
Fax Number	:

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

Provider Enumeration Date	:	06/16/2009
Last Update Date	:	10/28/2010

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