MEDICARE: MRS. SARAH MARIE WOMACK LMT

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	00622	IA

General Provider Information

NPI Number	:	1598153447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH MARIE WOMACK LMT

Provider Business Mailing Address
First Line	:	15672 490TH ST
Second Line	:
City	:	SCARVILLE
State	:	IA
Zip	:	50473-7526
Country	:	US
Telephone Number	:	640-591-5724
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 N MILL ST
Second Line	:
City	:	LAKE MILLS
State	:	IA
Zip	:	50450-1303
Country	:	US
Telephone Number	:	641-592-2888
Fax Number	:

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

Provider Enumeration Date	:	12/30/2014
Last Update Date	:	12/30/2014

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