MEDICARE: ELIZABETH PAKENHAM

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	018426-1	NY

General Provider Information

NPI Number	:	1003212671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH PAKENHAM

Provider Business Mailing Address
First Line	:	67 W BIHRWOOD DR
Second Line	:
City	:	WEST SENECA
State	:	NY
Zip	:	14224-3625
Country	:	US
Telephone Number	:	716-864-7320
Fax Number	:

Provider Business Practice Location Address
First Line	:	2437 BERG RD
Second Line	:
City	:	WEST SENECA
State	:	NY
Zip	:	14218-3785
Country	:	US
Telephone Number	:	716-864-7320
Fax Number	:

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

Provider Enumeration Date	:	11/10/2014
Last Update Date	:	11/10/2014

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