=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912371014
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCAFEE MASSAGE & BODYWORKS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2015
-----------------------------------------------------
Last Update Date | 11/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3043 RIVERVIEW DR
-----------------------------------------------------
City | FAIRBANKS
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99709-4737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-378-5385
-----------------------------------------------------
Fax | 907-374-1815
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3043 RIVERVIEW DR
-----------------------------------------------------
City | FAIRBANKS
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99709-4737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-378-5385
-----------------------------------------------------
Fax | 907-374-1815
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MASSAGE THERAPIST
-----------------------------------------------------
Name | KAREN LOUISE MCAFEE
-----------------------------------------------------
Credential | MT
-----------------------------------------------------
Telephone | 907-378-5385
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 104453
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------