MEDICARE: MRS. MICHELLE A MCDONALD 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	174400000X	Specialist	MA00003344	WA
2	225700000X	Massage Therapist	11914	MT

General Provider Information

NPI Number	:	1306986708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE A MCDONALD LMP

Provider Business Mailing Address
First Line	:	1601 2ND AVE N STE 217
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-3243
Country	:	US
Telephone Number	:	253-350-1928
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 2ND AVE N STE 217
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-3243
Country	:	US
Telephone Number	:	253-630-6768
Fax Number	:

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	02/18/2025

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