MEDICARE: MRS. SHAY LEAH BELLASEA 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	MA 60739078	WA

General Provider Information

NPI Number	:	1396277992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHAY LEAH BELLASEA LMT

Provider Business Mailing Address
First Line	:	4130 SW AUSTIN ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-2110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4130 SW AUSTIN ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-2110
Country	:	US
Telephone Number	:	419-350-3357
Fax Number	:

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

Provider Enumeration Date	:	04/01/2017
Last Update Date	:	03/28/2019

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