MEDICARE: SUSAN R KESTI 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	14127	OR
2	225700000X	Massage Therapist	MA00023462	WA
3	225700000X	Massage Therapist	4590	CA

General Provider Information

NPI Number	:	1477787166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN R KESTI LMP

Provider Business Mailing Address
First Line	:	1116 CARSON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45205-1726
Country	:	US
Telephone Number	:	513-448-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1116 CARSON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45205-1726
Country	:	US
Telephone Number	:	513-448-5000
Fax Number	:

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

Provider Enumeration Date	:	05/08/2009
Last Update Date	:	04/20/2012

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