MEDICARE: MISS ELISABETH SAMUEL 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	MA60412387	WA

General Provider Information

NPI Number	:	1528477916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ELISABETH SAMUEL LMP

Provider Business Mailing Address
First Line	:	1756 IOWA STREET
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98229-4701
Country	:	US
Telephone Number	:	360-734-9555
Fax Number	:	360-734-9556

Provider Business Practice Location Address
First Line	:	1756 IOWA ST
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98229-4702
Country	:	US
Telephone Number	:	360-734-9555
Fax Number	:	360-734-9556

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

Provider Enumeration Date	:	08/11/2014
Last Update Date	:	08/11/2014

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