MEDICARE: MS. KIMBERLY IRENE RICHEY 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	3130	SC

General Provider Information

NPI Number	:	1215182589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY IRENE RICHEY L.M.T.

Provider Business Mailing Address
First Line	:	700 DANIEL ELLIS DR
Second Line	:	UNIT 3203
City	:	CHARLESTON
State	:	SC
Zip	:	29412-3034
Country	:	US
Telephone Number	:	843-330-9033
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 DANIEL ELLIS DR
Second Line	:	UNIT 3203
City	:	CHARLESTON
State	:	SC
Zip	:	29412-3034
Country	:	US
Telephone Number	:	843-330-9033
Fax Number	:

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

Provider Enumeration Date	:	11/29/2008
Last Update Date	:	11/29/2008

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