MEDICARE: MS. LEAH HAWTIN 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	MA00009902	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0112241	OTHER	WA	L&I PROVIDER #

General Provider Information

NPI Number	:	1619065307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEAH HAWTIN LMP

Provider Business Mailing Address
First Line	:	PO BOX 65982
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98464-0050
Country	:	US
Telephone Number	:	253-777-6936
Fax Number	:

Provider Business Practice Location Address
First Line	:	6915 LAKEWOOD DR W STE A2
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98467-3299
Country	:	US
Telephone Number	:	253-777-6936
Fax Number	:

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	06/12/2012

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