MEDICARE: MICHELLE NEVILLE L.M.P.

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	MA00016612	WA

General Provider Information

NPI Number	:	1548499734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE NEVILLE L.M.P.

Provider Business Mailing Address
First Line	:	2206 QUEEN ANNE AVE N
Second Line	:	SUITE 202
City	:	SEATTLE
State	:	WA
Zip	:	98109-2370
Country	:	US
Telephone Number	:	206-378-5755
Fax Number	:	206-219-0556

Provider Business Practice Location Address
First Line	:	2206 QUEEN ANNE AVE N
Second Line	:	SUITE 202
City	:	SEATTLE
State	:	WA
Zip	:	98109-2370
Country	:	US
Telephone Number	:	206-378-5755
Fax Number	:	206-219-0556

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

Provider Enumeration Date	:	07/08/2009
Last Update Date	:	07/08/2009

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