MEDICARE: MS. KATHLEEN M OCEAN 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	MT138	ME

General Provider Information

NPI Number	:	1013176049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN M OCEAN LMT

Provider Business Mailing Address
First Line	:	PO BOX 625
Second Line	:
City	:	WALDOBORO
State	:	ME
Zip	:	04572-0625
Country	:	US
Telephone Number	:	207-832-6347
Fax Number	:	207-832-4664

Provider Business Practice Location Address
First Line	:	290 BREMEN RD
Second Line	:
City	:	WALDOBORO
State	:	ME
Zip	:	04572
Country	:	US
Telephone Number	:	207-832-6347
Fax Number	:	207-832-4664

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

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	06/05/2008

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