MEDICARE: MARY JANE HIGGASON 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	TEMP128	SD

General Provider Information

NPI Number	:	1346978004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JANE HIGGASON LMT

Provider Business Mailing Address
First Line	:	4420 W 35TH ST N APT 210
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57107-2074
Country	:	US
Telephone Number	:	605-929-1172
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N KROHN PL
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57103-1815
Country	:	US
Telephone Number	:	605-321-8838
Fax Number	:

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

Provider Enumeration Date	:	08/10/2022
Last Update Date	:	08/10/2022

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