MEDICARE: ILANA MCCALL 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	MA61093257	WA

General Provider Information

NPI Number	:	1770208829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILANA MCCALL LMT

Provider Business Mailing Address
First Line	:	26418 BARRETT RD NE
Second Line	:
City	:	KINGSTON
State	:	WA
Zip	:	98346-9344
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 WINSLOW WAY E STE 216
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-2438
Country	:	US
Telephone Number	:	702-378-7585
Fax Number	:

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

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	10/11/2022

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