MEDICARE: NICOLE BRANSON 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	MA60259138	WA

General Provider Information

NPI Number	:	1811247000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE BRANSON LMP

Provider Business Mailing Address
First Line	:	1526 BISHOP RD SW
Second Line	:
City	:	TUMWATER
State	:	WA
Zip	:	98512-7354
Country	:	US
Telephone Number	:	360-459-9000
Fax Number	:	360-459-9183

Provider Business Practice Location Address
First Line	:	111 TUMWATER BLVD SE # B106
Second Line	:
City	:	TUMWATER
State	:	WA
Zip	:	98501-6400
Country	:	US
Telephone Number	:	360-786-8600
Fax Number	:

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

Provider Enumeration Date	:	09/14/2012
Last Update Date	:	08/12/2014

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