MEDICARE: MS. SUSAN BETH WOZNIAK 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	MA00009649	WA

General Provider Information

NPI Number	:	1710021050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN BETH WOZNIAK LMP

Provider Business Mailing Address
First Line	:	7701 23RD AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-4318
Country	:	US
Telephone Number	:	206-898-2342
Fax Number	:

Provider Business Practice Location Address
First Line	:	7701 23RD AVE NW
Second Line	:	4511 WALLINGFORD AVE N
City	:	SEATTLE
State	:	WA
Zip	:	98117-4318
Country	:	US
Telephone Number	:	206-782-1805
Fax Number	:

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	07/08/2008

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