MEDICARE: HEATHER CHISHOLM OWENS LMP CIMI

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	MA00007470	WA

General Provider Information

NPI Number	:	1124198346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER CHISHOLM OWENS LMP CIMI

Provider Business Mailing Address
First Line	:	3433 227TH ST SW
Second Line	:
City	:	BRIER
State	:	WA
Zip	:	98036
Country	:	US
Telephone Number	:	206-660-0907
Fax Number	:	206-675-1043

Provider Business Practice Location Address
First Line	:	5355 TALLMAN AVE NW STE 214
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-3935
Country	:	US
Telephone Number	:	206-660-0907
Fax Number	:	206-675-1043

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/21/2022

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