MEDICARE: MRS. CAROLINE MADY WAGGONER L.M.P.

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	MA00021632	WA

General Provider Information

NPI Number	:	1952529083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLINE MADY WAGGONER L.M.P.

Provider Business Mailing Address
First Line	:	PO BOX 162
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-0162
Country	:	US
Telephone Number	:	206-328-3164
Fax Number	:

Provider Business Practice Location Address
First Line	:	1222 SUMMIT AVE
Second Line	:	# 307
City	:	SEATTLE
State	:	WA
Zip	:	98101-4239
Country	:	US
Telephone Number	:	206-328-3164
Fax Number	:

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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