MEDICARE: KIMBERLY WHITE 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	MA00018493	WA

General Provider Information

NPI Number	:	1902013386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY WHITE LMP

Provider Business Mailing Address
First Line	:	P.O. BOX 2706
Second Line	:
City	:	POULSBO
State	:	WA
Zip	:	98370
Country	:	US
Telephone Number	:	360-697-3767
Fax Number	:	360-697-5927

Provider Business Practice Location Address
First Line	:	18820 FRONT ST.
Second Line	:	220
City	:	POULSBO
State	:	WA
Zip	:	98370
Country	:	US
Telephone Number	:	360-697-3767
Fax Number	:	360-697-5927

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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Directions to “ KIMBERLY WHITE LMP” Practice Location

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