MEDICARE: MELISSA M WARD MASSAGE THERAPIST

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	60320908	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1790148781	OTHER	WA	NPPES

General Provider Information

NPI Number	:	1891397410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA M WARD MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	5107 N ELM ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99205-5544
Country	:	US
Telephone Number	:	509-599-1196
Fax Number	:

Provider Business Practice Location Address
First Line	:	1414 W GARLAND AVE STE 111
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99205-2615
Country	:	US
Telephone Number	:	509-599-1196
Fax Number	:

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

Provider Enumeration Date	:	11/09/2020
Last Update Date	:	11/09/2020

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