MEDICARE: ASHLEY KINGSTON 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	MA60434722	WA

General Provider Information

NPI Number	:	1659786200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY KINGSTON LMP

Provider Business Mailing Address
First Line	:	2554 S MERIDIAN APT C
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98373-1527
Country	:	US
Telephone Number	:	253-720-7816
Fax Number	:

Provider Business Practice Location Address
First Line	:	818 39TH AVE SW
Second Line	:	SUITE A
City	:	PUYALLUP
State	:	WA
Zip	:	98373-3308
Country	:	US
Telephone Number	:	253-841-2200
Fax Number	:

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

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	06/23/2014

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