MEDICARE: MRS. MARY E KULISCH LMT

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	MA00020466	WA

General Provider Information

NPI Number	:	1245351402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY E KULISCH LMT

Provider Business Mailing Address
First Line	:	22910 E APPLEWAY AVE
Second Line	:	SUITE 7
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-8605
Country	:	US
Telephone Number	:	509-242-0911
Fax Number	:	509-242-0913

Provider Business Practice Location Address
First Line	:	22910 E APPLEWAY AVE
Second Line	:	SUITE 7
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-8605
Country	:	US
Telephone Number	:	509-242-0911
Fax Number	:	509-242-0913

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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