MEDICARE: MRS. SHAUNA C FONTAINE 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	MA00024898	WA

General Provider Information

NPI Number	:	1699097600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHAUNA C FONTAINE LMP

Provider Business Mailing Address
First Line	:	3507 NE SUNSET BLVD
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98056-3330
Country	:	US
Telephone Number	:	425-277-0222
Fax Number	:	425-277-0246

Provider Business Practice Location Address
First Line	:	3507 NE SUNSET BLVD
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98056-3330
Country	:	US
Telephone Number	:	425-277-0222
Fax Number	:	425-277-0246

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

Provider Enumeration Date	:	02/17/2010
Last Update Date	:	02/17/2010

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