MEDICARE: MS. AMBER DAWN VALENTINE 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	MA60209214	WA

General Provider Information

NPI Number	:	1760780845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMBER DAWN VALENTINE LMP

Provider Business Mailing Address
First Line	:	17515 CLEAR LAKE BLVD SE
Second Line	:
City	:	YELM
State	:	WA
Zip	:	98597-8976
Country	:	US
Telephone Number	:	360-894-1543
Fax Number	:

Provider Business Practice Location Address
First Line	:	17515 CLEAR LAKE BLVD SE
Second Line	:
City	:	YELM
State	:	WA
Zip	:	98597-8976
Country	:	US
Telephone Number	:	360-894-1543
Fax Number	:

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

Provider Enumeration Date	:	03/14/2011
Last Update Date	:	03/14/2011

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