MEDICARE: MISS MARY ANN MILLER 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	MA00016970	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	204320615	OTHER	WA	AXIA HEALTH NETWORK

General Provider Information

NPI Number	:	1295859130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARY ANN MILLER LMP

Provider Business Mailing Address
First Line	:	PO BOX 1267
Second Line	:
City	:	EPHRATA
State	:	WA
Zip	:	98823-1699
Country	:	US
Telephone Number	:	360-286-8151
Fax Number	:

Provider Business Practice Location Address
First Line	:	318 MAIN AVENUE EAST
Second Line	:
City	:	SOAP LAKE
State	:	WA
Zip	:	98851
Country	:	US
Telephone Number	:	509-246-1660
Fax Number	:	509-246-1660

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

Provider Enumeration Date	:	03/17/2007
Last Update Date	:	07/03/2008

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Directions to “ MISS MARY ANN MILLER LMP” Practice Location

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