MEDICARE: MRS. MARGO CHANG 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	MA60285028	WA

General Provider Information

NPI Number	:	1770829590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARGO CHANG LMP

Provider Business Mailing Address
First Line	:	6787 N VAN DECAR RD SE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98367-8506
Country	:	US
Telephone Number	:	262-617-8623
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 VERNHARDSON ST
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98332-2135
Country	:	US
Telephone Number	:	253-857-3425
Fax Number	:

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

Provider Enumeration Date	:	12/26/2012
Last Update Date	:	12/26/2012

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