MEDICARE: KIRSTEN LOTTSFELDT 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	MA00011136	WA

General Provider Information

NPI Number	:	1508158502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN LOTTSFELDT LMP

Provider Business Mailing Address
First Line	:	1246 S 117TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98168-2162
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 OLIVE WAY STE 1358
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-2549
Country	:	US
Telephone Number	:	206-922-3342
Fax Number	:

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

Provider Enumeration Date	:	05/09/2011
Last Update Date	:	05/09/2011

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