MEDICARE: YOLANDA SAKUMA 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
2	225700000X	Massage Therapist	MA00019667	WA

General Provider Information

NPI Number	:	1427249606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOLANDA SAKUMA LMP

Provider Business Mailing Address
First Line	:	405 VINE ST
Second Line	:
City	:	BURLINGTON
State	:	WA
Zip	:	98233-2532
Country	:	US
Telephone Number	:	360-421-0435
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 S 11TH ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4025
Country	:	US
Telephone Number	:	360-421-0435
Fax Number	:	360-404-3906

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

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	07/21/2022

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