MEDICARE: MS. LORI L ANDERSON 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	MA00010877	WA

General Provider Information

NPI Number	:	1336213909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORI L ANDERSON LMP

Provider Business Mailing Address
First Line	:	11628 OLALLA VALLEY RD SE
Second Line	:
City	:	OLALLA
State	:	WA
Zip	:	98359-0023
Country	:	US
Telephone Number	:	253-861-0850
Fax Number	:

Provider Business Practice Location Address
First Line	:	10100 BRIDGEPORT WAY SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-2302
Country	:	US
Telephone Number	:	253-861-0850
Fax Number	:	253-983-9747

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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