MEDICARE: AUNDREA KERR 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	MA00023032	WA

General Provider Information

NPI Number	:	1366649543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUNDREA KERR LMP

Provider Business Mailing Address
First Line	:	2821 SW NEVADA ST
Second Line	:	APT C
City	:	SEATTLE
State	:	WA
Zip	:	98126
Country	:	US
Telephone Number	:	206-708-5562
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 NEVADA ST SW
Second Line	:	APT C
City	:	SEATTLE
State	:	WA
Zip	:	98126
Country	:	US
Telephone Number	:	206-708-5568
Fax Number	:

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

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	07/08/2007

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