MEDICARE: MS. KERI L NOTTINGHAM 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	MA00019341	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	193034	OTHER	WA	DEPT OF L&I
2	8939818	OTHER	WA	CRIME VICTIMS
3	1522NO	OTHER	WA	REGENCE BS

General Provider Information

NPI Number	:	1821080557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KERI L NOTTINGHAM LMP

Provider Business Mailing Address
First Line	:	PO BOX 731269
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98373-0060
Country	:	US
Telephone Number	:	253-840-2313
Fax Number	:	253-840-6340

Provider Business Practice Location Address
First Line	:	8910 184TH AVE E
Second Line	:
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-8531
Country	:	US
Telephone Number	:	253-863-7510
Fax Number	:	253-863-5970

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	07/08/2007

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