MEDICARE: MS. JAMIE JEFFERSON 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	MA00016861	WA

General Provider Information

NPI Number	:	1043412570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAMIE JEFFERSON L.M.P.

Provider Business Mailing Address
First Line	:	8625 49TH DR NE
Second Line	:
City	:	MARYSVILLE
State	:	WA
Zip	:	98270-3011
Country	:	US
Telephone Number	:	425-280-5481
Fax Number	:	360-925-6672

Provider Business Practice Location Address
First Line	:	8625 49TH DR NE
Second Line	:
City	:	MARYSVILLE
State	:	WA
Zip	:	98270-3011
Country	:	US
Telephone Number	:	425-280-5481
Fax Number	:	360-925-6672

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

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	03/11/2008

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