MEDICARE: MRS. ELLEN JEAN MAY LMT

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	60861804	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60861804	OTHER	WA	WA STATE DEPT OF HEALTH

General Provider Information

NPI Number	:	1710451745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELLEN JEAN MAY LMT

Provider Business Mailing Address
First Line	:	2814 S DAYTON ST
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99337-5056
Country	:	US
Telephone Number	:	509-737-7042
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 COLUMBIA PARK TRL STE 101
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99352-4772
Country	:	US
Telephone Number	:	509-591-0462
Fax Number	:

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

Provider Enumeration Date	:	01/12/2019
Last Update Date	:	01/12/2019

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