MEDICARE: CASSANDRA ANN SMITH

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

General Provider Information

NPI Number	:	1689189649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA ANN SMITH

Provider Business Mailing Address
First Line	:	710 GEORGIANA ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-3510
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 GEORGIANA ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-3510
Country	:	US
Telephone Number	:	360-565-6228
Fax Number	:

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

Provider Enumeration Date	:	12/12/2017
Last Update Date	:	12/12/2017

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Directions to “ CASSANDRA ANN SMITH ” Practice Location

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