MEDICARE: MR. JIRAYA MICHIO ADDAMS 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	MA00013087	WA

General Provider Information

NPI Number	:	1477693000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JIRAYA MICHIO ADDAMS LMP

Provider Business Mailing Address
First Line	:	901 BOREN AVE
Second Line	:	SUITE 1700 (LONG LIFE ACU)
City	:	SEATTLE
State	:	WA
Zip	:	98104-3595
Country	:	US
Telephone Number	:	206-323-6824
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 BOREN AVE
Second Line	:	SUITE 1700 (LONG LIFE ACU)
City	:	SEATTLE
State	:	WA
Zip	:	98104-3595
Country	:	US
Telephone Number	:	206-323-6824
Fax Number	:

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	06/06/2014

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