MEDICARE: MS. DAWN MARIE SHOEMAKER 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	MA60307926

General Provider Information

NPI Number	:	1548511181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DAWN MARIE SHOEMAKER LMP

Provider Business Mailing Address
First Line	:	2916 NW BUCKLIN HILL RD
Second Line	:	#384
City	:	SILVERDALE
State	:	WA
Zip	:	98383-8514
Country	:	US
Telephone Number	:	360-434-6959
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 SE MILE HILL DR
Second Line	:	A-101
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3500
Country	:	US
Telephone Number	:	360-895-4843
Fax Number	:

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

Provider Enumeration Date	:	09/23/2012
Last Update Date	:	09/23/2012

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