MEDICARE: MARISA CATHERINE THURN L.M.T.

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	MT20900414	IN
2	246RP1900X	Phlebotomy Technician	Q4X8C6F4	IN

General Provider Information

NPI Number	:	1891032470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA CATHERINE THURN L.M.T.

Provider Business Mailing Address
First Line	:	1301 FLETCHER AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-1140
Country	:	US
Telephone Number	:	317-514-5089
Fax Number	:	317-677-8691

Provider Business Practice Location Address
First Line	:	1301 FLETCHER AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-1140
Country	:	US
Telephone Number	:	317-514-5089
Fax Number	:	317-677-8691

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

Provider Enumeration Date	:	01/15/2013
Last Update Date	:	04/24/2015

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