MEDICARE: MS. MARY PAMELA DOOLEY 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	33.024000	OH

General Provider Information

NPI Number	:	1629534672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY PAMELA DOOLEY LMT

Provider Business Mailing Address
First Line	:	1505 BETHEL RD STE 103
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2055
Country	:	US
Telephone Number	:	614-414-2749
Fax Number	:	614-846-9709

Provider Business Practice Location Address
First Line	:	1505 BETHEL RD STE 103
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2055
Country	:	US
Telephone Number	:	614-414-2749
Fax Number	:	614-864-9709

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

Provider Enumeration Date	:	02/14/2019
Last Update Date	:	02/15/2019

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