MEDICARE: MOLLY E BURROUGHS 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	33-017851	OH

General Provider Information

NPI Number	:	1720211394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY E BURROUGHS LMT

Provider Business Mailing Address
First Line	:	7277 SMITHS MILL RD
Second Line	:
City	:	NEW ALBANY
State	:	OH
Zip	:	43054-8195
Country	:	US
Telephone Number	:	614-381-3370
Fax Number	:

Provider Business Practice Location Address
First Line	:	4303 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-1577
Country	:	US
Telephone Number	:	614-418-7122
Fax Number	:	614-418-7124

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

Provider Enumeration Date	:	08/31/2009
Last Update Date	:	12/23/2013

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