MEDICARE: E. LORI HENKEL 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	MA00012370	WA

General Provider Information

NPI Number	:	1184844631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	E. LORI HENKEL LMP

Provider Business Mailing Address
First Line	:	104 W 4TH ST
Second Line	:	#106
City	:	ABERDEEN
State	:	WA
Zip	:	98520-3932
Country	:	US
Telephone Number	:	360-533-7276
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 W 4TH ST
Second Line	:	#106
City	:	ABERDEEN
State	:	WA
Zip	:	98520-3932
Country	:	US
Telephone Number	:	360-533-7276
Fax Number	:

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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