MEDICARE: MISS PATTI JEAN PILCH 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	#00011635	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00011635	OTHER	WA	LMP#
2	118508	OTHER	WA	LABOR & INDUSTRY #
3	752986678-01	OTHER	WA	KPS #

General Provider Information

NPI Number	:	1245473412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PATTI JEAN PILCH LMP

Provider Business Mailing Address
First Line	:	2507 MILE HILL DRIVE
Second Line	:	SUITE C8
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366
Country	:	US
Telephone Number	:	360-895-2664
Fax Number	:	360-895-2664

Provider Business Practice Location Address
First Line	:	2507 MILE HILL DRIVE
Second Line	:	SUITE C8
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366
Country	:	US
Telephone Number	:	360-895-2664
Fax Number	:	360-895-2664

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

Provider Enumeration Date	:	04/17/2009
Last Update Date	:	04/17/2009

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Directions to “ MISS PATTI JEAN PILCH LMP” Practice Location

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