MEDICARE: FAWN C ADAMS 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	MA 00025015	WA

General Provider Information

NPI Number	:	1457526246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAWN C ADAMS LMP

Provider Business Mailing Address
First Line	:	4707 E UPRIVER DR APT K102
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99217-7387
Country	:	US
Telephone Number	:	509-435-7467
Fax Number	:

Provider Business Practice Location Address
First Line	:	13701 E SPRAGUE AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-0811
Country	:	US
Telephone Number	:	509-922-5585
Fax Number	:

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

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	04/10/2015

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Directions to “ FAWN C ADAMS LMP” Practice Location

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