MEDICARE: DANA L KIRKWOOD-WATTS 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	MA00023864	WA

General Provider Information

NPI Number	:	1699939017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA L KIRKWOOD-WATTS LMP

Provider Business Mailing Address
First Line	:	5100 S DAWSON ST
Second Line	:	STE 104
City	:	SEATTLE
State	:	WA
Zip	:	98118-2100
Country	:	US
Telephone Number	:	206-760-1448
Fax Number	:	206-760-1730

Provider Business Practice Location Address
First Line	:	5100 S DAWSON ST
Second Line	:	STE 104
City	:	SEATTLE
State	:	WA
Zip	:	98118-2100
Country	:	US
Telephone Number	:	206-760-1448
Fax Number	:	206-760-1730

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

Provider Enumeration Date	:	07/15/2008
Last Update Date	:	07/01/2010

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