MEDICARE: MRS. VAYDA MARIE STAPLETON 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	MA 00014381	WA

General Provider Information

NPI Number	:	1205154994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VAYDA MARIE STAPLETON LMP

Provider Business Mailing Address
First Line	:	1915 NE 389TH ST
Second Line	:
City	:	WOODLAND
State	:	WA
Zip	:	98674-3630
Country	:	US
Telephone Number	:	360-263-4061
Fax Number	:

Provider Business Practice Location Address
First Line	:	9705 NE HAZEL DELL AVE
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98665-8056
Country	:	US
Telephone Number	:	360-433-1956
Fax Number	:

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

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	05/06/2010

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