MEDICARE: MRS. KRISTINE LOUISE SMITH 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	MA00015322	WA

General Provider Information

NPI Number	:	1033431887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTINE LOUISE SMITH L.M.P

Provider Business Mailing Address
First Line	:	1400 W WASHINGTON ST STE 104
Second Line	:	#364
City	:	SEQUIM
State	:	WA
Zip	:	98382-3236
Country	:	US
Telephone Number	:	360-797-5832
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 E WASHINGTON ST STE A
Second Line	:
City	:	SEQUIM
State	:	WA
Zip	:	98382-4107
Country	:	US
Telephone Number	:	360-797-5832
Fax Number	:

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

Provider Enumeration Date	:	02/22/2010
Last Update Date	:	09/11/2014

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