MEDICARE: MRS. CATHERINE MACDONALD L.M.T.

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	227.010121	IL

General Provider Information

NPI Number	:	1184978223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHERINE MACDONALD L.M.T.

Provider Business Mailing Address
First Line	:	6803 ROOSEVELT RD
Second Line	:	APT. 2
City	:	BERWYN
State	:	IL
Zip	:	60402-1090
Country	:	US
Telephone Number	:	630-639-1730
Fax Number	:

Provider Business Practice Location Address
First Line	:	1048 OGDEN AVE
Second Line	:	SUITE 120
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-2894
Country	:	US
Telephone Number	:	630-639-1730
Fax Number	:

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

Provider Enumeration Date	:	10/26/2012
Last Update Date	:	10/26/2012

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