MEDICARE: JENNIFER DAILEY 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	MA 60041366	WA

General Provider Information

NPI Number	:	1417193277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DAILEY LMP

Provider Business Mailing Address
First Line	:	3603 S. MCCLELLAN ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144
Country	:	US
Telephone Number	:	206-356-0912
Fax Number	:

Provider Business Practice Location Address
First Line	:	3603 S. MCCLELLAN ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144
Country	:	US
Telephone Number	:	206-356-0912
Fax Number	:

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

Provider Enumeration Date	:	12/29/2008
Last Update Date	:	12/09/2021

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