MEDICARE: UNRAVEL, LLC

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	171100000X	Acupuncturist	AC0000646	WA
2	225700000X	Massage Therapist	MA00005106	WA

General Provider Information

NPI Number	:	1407095102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNRAVEL, LLC

Provider Business Mailing Address
First Line	:	3320 W. MCGRAW ST
Second Line	:	#4
City	:	SEATTLE
State	:	WA
Zip	:	98199-3241
Country	:	US
Telephone Number	:	206-283-9910
Fax Number	:	206-283-9935

Provider Business Practice Location Address
First Line	:	3320 W. MCGRAW ST
Second Line	:	#4
City	:	SEATTLE
State	:	WA
Zip	:	98199-3241
Country	:	US
Telephone Number	:	206-283-9910
Fax Number	:	206-283-9935

Authorized Official
Title or Position	:	OWNER
Name	:	SHERYLL LYNNE GREGORY
Credential	:	LMP
Telephone Number	:	206-283-9910

Provider Enumeration Date	:	02/19/2009
Last Update Date	:	02/19/2009

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Directions to “UNRAVEL, LLC ” Practice Location

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