MEDICARE: CHARYLIE ABERNATHY L.M.P.

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 60571522	WA

General Provider Information

NPI Number	:	1598148959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARYLIE ABERNATHY L.M.P.

Provider Business Mailing Address
First Line	:	8008 GREENWOOD AVE N APT 202
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-4244
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8008 GREENWOOD AVE N APT 202
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-4244
Country	:	US
Telephone Number	:	360-853-3215
Fax Number	:

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

Provider Enumeration Date	:	07/02/2015
Last Update Date	:	07/02/2015

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