MEDICARE: MS. HOLLIE IRISH 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	MA00015501	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0160267	OTHER	WA	DEPARTMENT OF L&I

General Provider Information

NPI Number	:	1619031713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLIE IRISH LMP

Provider Business Mailing Address
First Line	:	10700 SE 208TH ST STE 207
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98031-5545
Country	:	US
Telephone Number	:	253-854-3185
Fax Number	:

Provider Business Practice Location Address
First Line	:	10700 SE 208TH ST STE 207
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98031-5545
Country	:	US
Telephone Number	:	253-854-3185
Fax Number	:

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	07/08/2007

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