MEDICARE: JESSICA ALYSSA SPILLMAN LMT

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	MA61233520	WA

General Provider Information

NPI Number	:	1740983345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ALYSSA SPILLMAN LMT

Provider Business Mailing Address
First Line	:	20 N WIGEON PL
Second Line	:
City	:	HOODSPORT
State	:	WA
Zip	:	98548-9527
Country	:	US
Telephone Number	:	775-360-0730
Fax Number	:

Provider Business Practice Location Address
First Line	:	LAKE CUSHMAN
Second Line	:
City	:	HOODSPORT
State	:	WA
Zip	:	98548-9854
Country	:	US
Telephone Number	:	775-360-0730
Fax Number	:

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

Provider Enumeration Date	:	03/23/2023
Last Update Date	:	03/23/2023

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