MEDICARE: MRS. SUZAN MARIE KINKEL 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	MA00012701	WA

General Provider Information

NPI Number	:	1558433532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZAN MARIE KINKEL LMP

Provider Business Mailing Address
First Line	:	2029 W 9TH PL
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-5218
Country	:	US
Telephone Number	:	509-585-8493
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 W CLEARWATER AVE
Second Line	:	SUITE 5
City	:	KENNEWICK
State	:	WA
Zip	:	99336-2709
Country	:	US
Telephone Number	:	509-737-0610
Fax Number	:	509-737-8731

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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