MEDICARE: LORRISSA MOULLET LMP

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	MA60581291	WA

General Provider Information

NPI Number	:	1144690397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORRISSA MOULLET LMP

Provider Business Mailing Address
First Line	:	736 N 80TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-4312
Country	:	US
Telephone Number	:	206-380-7698
Fax Number	:

Provider Business Practice Location Address
First Line	:	736 N 80TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-4312
Country	:	US
Telephone Number	:	206-380-7698
Fax Number	:

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

Provider Enumeration Date	:	09/30/2015
Last Update Date	:	09/30/2015

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Directions to “ LORRISSA MOULLET LMP” Practice Location

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