MEDICARE: DENISE NOVOTNY

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	MASS.MA.60890367	WA

General Provider Information

NPI Number	:	1679041784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE NOVOTNY

Provider Business Mailing Address
First Line	:	7724 35TH AVE NE UNIT 19561
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-9955
Country	:	US
Telephone Number	:	206-234-1766
Fax Number	:

Provider Business Practice Location Address
First Line	:	7724 35TH AVE NE UNIT 19561
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-9955
Country	:	US
Telephone Number	:	206-234-1766
Fax Number	:

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

Provider Enumeration Date	:	11/06/2018
Last Update Date	:	11/06/2018

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Directions to “ DENISE NOVOTNY ” Practice Location

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