MEDICARE: SARA R SALI 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	174400000X	Specialist	MA00013324	WA

General Provider Information

NPI Number	:	1790905651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA R SALI LMP

Provider Business Mailing Address
First Line	:	PO BOX 2116
Second Line	:
City	:	KINGSTON
State	:	WA
Zip	:	98346-2116
Country	:	US
Telephone Number	:	206-300-0673
Fax Number	:

Provider Business Practice Location Address
First Line	:	11700 MEADOWMEER CIR NE
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-4202
Country	:	US
Telephone Number	:	206-842-5661
Fax Number	:	206-842-5662

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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