MEDICARE: JENNINE WOODS MCLAUGHLIN 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	MA00004138	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	81439	OTHER	WA	WA L&I PROVIDER NUMBER

General Provider Information

NPI Number	:	1992833313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNINE WOODS MCLAUGHLIN LMT

Provider Business Mailing Address
First Line	:	4310 S FERDINAND ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-2017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12419 RENTON AVE S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98178-3708
Country	:	US
Telephone Number	:	206-772-0088
Fax Number	:

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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