MEDICARE: MS. SUSAN KAY HOVDA I 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	173C00000X	Reflexologist
2	173C00000X	Reflexologist	MA00015713	WA
3	225700000X	Massage Therapist	MA00015713	WA

General Provider Information

NPI Number	:	1902042682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN KAY HOVDA I MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	BOX 116
Second Line	:
City	:	SOUTH CLEELUM
State	:	WA
Zip	:	98943
Country	:	US
Telephone Number	:	509-674-2822
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 RAIL ROAD STREET
Second Line	:
City	:	CLEELUM
State	:	WA
Zip	:	98922
Country	:	US
Telephone Number	:	509-674-2822
Fax Number	:

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

Provider Enumeration Date	:	12/30/2008
Last Update Date	:	11/09/2012

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