MEDICARE: MICHAEL E MACKINNON

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	9722	CO

General Provider Information

NPI Number	:	1649514506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL E MACKINNON

Provider Business Mailing Address
First Line	:	465 TAMARACK DR UNIT 208
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-3167
Country	:	US
Telephone Number	:	401-575-8214
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 S LINCOLN AVE
Second Line	:	SUITE A
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-1789
Country	:	US
Telephone Number	:	970-875-2731
Fax Number	:

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

Provider Enumeration Date	:	11/16/2012
Last Update Date	:	11/16/2012

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Directions to “ MICHAEL E MACKINNON ” Practice Location

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