MEDICARE: MS. BETTY W. ULMANIS LMT, CMMMT, NCTMB

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	MA00015324	WA

General Provider Information

NPI Number	:	1639387707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BETTY W. ULMANIS LMT, CMMMT, NCTMB

Provider Business Mailing Address
First Line	:	7196 EVANS RD.
Second Line	:
City	:	EAU CLAIRE
State	:	MI
Zip	:	49111
Country	:	US
Telephone Number	:	269-251-0327
Fax Number	:

Provider Business Practice Location Address
First Line	:	9067 US HIGHWAY 31
Second Line	:	SUITE #209
City	:	BERRIEN SPRINGS
State	:	MI
Zip	:	49103-1664
Country	:	US
Telephone Number	:	269-251-0327
Fax Number	:

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

Provider Enumeration Date	:	05/20/2007
Last Update Date	:	01/14/2011

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