MEDICARE: MS. SKYE LIVINGSTON 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	S10-094	CA
2	225700000X	Massage Therapist	2007004976	MO

General Provider Information

NPI Number	:	1861704579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SKYE LIVINGSTON LMT

Provider Business Mailing Address
First Line	:	912 E 18TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94606-3032
Country	:	US
Telephone Number	:	510-928-7818
Fax Number	:	510-533-8485

Provider Business Practice Location Address
First Line	:	912 E 18TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94606-3032
Country	:	US
Telephone Number	:	510-928-7818
Fax Number	:	510-533-8485

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

Provider Enumeration Date	:	07/10/2010
Last Update Date	:	07/10/2010

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