MEDICARE: MARILYN DECILLIS

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	93119	CA

General Provider Information

NPI Number	:	1275659393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN DECILLIS

Provider Business Mailing Address
First Line	:	5468 THUNDER RIDGE CIR
Second Line	:
City	:	ROCKLIN
State	:	CA
Zip	:	95765-4854
Country	:	US
Telephone Number	:	916-624-5410
Fax Number	:

Provider Business Practice Location Address
First Line	:	2351 SUNSET BLVD
Second Line	:	SUITE 120
City	:	ROCKLIN
State	:	CA
Zip	:	95765-4338
Country	:	US
Telephone Number	:	916-624-5400
Fax Number	:

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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