MEDICARE: MS. KRISTA GILLIAN DUDOWARD 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	MA00016124	WA

General Provider Information

NPI Number	:	1154596161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTA GILLIAN DUDOWARD LMP

Provider Business Mailing Address
First Line	:	2717 ORLEANS STREET
Second Line	:	SUITE A
City	:	BELLINGHAM
State	:	WA
Zip	:	98226
Country	:	US
Telephone Number	:	360-739-0399
Fax Number	:

Provider Business Practice Location Address
First Line	:	2717 ORLEANS ST
Second Line	:	SUITE A
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-4658
Country	:	US
Telephone Number	:	360-739-0399
Fax Number	:

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

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	04/30/2008

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