MEDICARE: MISS KARI JO HAUGEN CMT

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		MN

General Provider Information

NPI Number	:	1104488774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KARI JO HAUGEN CMT

Provider Business Mailing Address
First Line	:	3708 E 34TH ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3708 E 34TH ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2702
Country	:	US
Telephone Number	:	612-722-0875
Fax Number	:

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

Provider Enumeration Date	:	07/03/2019
Last Update Date	:	07/03/2019

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