MEDICARE: MRS. RACHELLE MARIE BOONE 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 00015234	WA

General Provider Information

NPI Number	:	1518105667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHELLE MARIE BOONE LMP

Provider Business Mailing Address
First Line	:	23505 E APPLEWAY AVE
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-5061
Country	:	US
Telephone Number	:	509-893-3623
Fax Number	:

Provider Business Practice Location Address
First Line	:	23505 E APPLEWAY AVE
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-5061
Country	:	US
Telephone Number	:	509-893-3623
Fax Number	:

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

Provider Enumeration Date	:	01/28/2009
Last Update Date	:	01/28/2009

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