MEDICARE: MS. MAUREEN MITCHELL 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	11267	SC

General Provider Information

NPI Number	:	1588790455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAUREEN MITCHELL LMP

Provider Business Mailing Address
First Line	:	4049 GARY DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-8617
Country	:	US
Telephone Number	:	360-789-3836
Fax Number	:	360-400-1553

Provider Business Practice Location Address
First Line	:	4049 GARY DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-8617
Country	:	US
Telephone Number	:	360-789-3836
Fax Number	:

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	03/17/2024

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