MEDICARE: MS. DAWN M FIRTH 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		WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0031418	OTHER	WA	L & I

General Provider Information

NPI Number	:	1598887051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DAWN M FIRTH LMP

Provider Business Mailing Address
First Line	:	1617 GROVE ST
Second Line	:
City	:	MARYSVILLE
State	:	WA
Zip	:	98270-4301
Country	:	US
Telephone Number	:	360-659-6241
Fax Number	:	360-659-3918

Provider Business Practice Location Address
First Line	:	1617 GROVE ST
Second Line	:
City	:	MARYSVILLE
State	:	WA
Zip	:	98270-4301
Country	:	US
Telephone Number	:	360-659-6241
Fax Number	:	360-659-3918

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/25/2007

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