MEDICARE: MARC MAUPOUX 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	MA60403982	WA

General Provider Information

NPI Number	:	1710307442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC MAUPOUX LMP

Provider Business Mailing Address
First Line	:	433 BELMONT AVE E APT 208
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-6006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1523 E MADISON ST
Second Line	:	STE 7
City	:	SEATTLE
State	:	WA
Zip	:	98122-4013
Country	:	US
Telephone Number	:	206-491-4916
Fax Number	:

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

Provider Enumeration Date	:	04/21/2014
Last Update Date	:	04/21/2014

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Directions to “ MARC MAUPOUX LMP” Practice Location

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