MEDICARE: LAURA L GRAMLY -KELLEY L.AC, MTCM, MSW

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	171100000X	Acupuncturist	AC00002183	WA

General Provider Information

NPI Number	:	1770600264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA L GRAMLY -KELLEY L.AC, MTCM, MSW

Provider Business Mailing Address
First Line	:	11008 21ST AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98146-2045
Country	:	US
Telephone Number	:	206-932-6114
Fax Number	:	206-923-0577

Provider Business Practice Location Address
First Line	:	6053 CALIFORNIA AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-1612
Country	:	US
Telephone Number	:	206-932-6114
Fax Number	:	206-923-0577

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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