MEDICARE: MRS. CHEYENNE RENEE' STALLINGS 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	MA00019450	WA

General Provider Information

NPI Number	:	1538358692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHEYENNE RENEE' STALLINGS LMP

Provider Business Mailing Address
First Line	:	2916 NW BUCKLIN HILL RD
Second Line	:	#117
City	:	SILVERDALE
State	:	WA
Zip	:	98383-8514
Country	:	US
Telephone Number	:	360-265-9667
Fax Number	:

Provider Business Practice Location Address
First Line	:	15398 SEABECK HWY NW
Second Line	:
City	:	SEABECK
State	:	WA
Zip	:	98380-8704
Country	:	US
Telephone Number	:	360-265-9667
Fax Number	:

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

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	10/15/2007

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