MEDICARE: MARILYN ALICE OVERCAST 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	MA00005713	WA

General Provider Information

NPI Number	:	1932247343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN ALICE OVERCAST LMT

Provider Business Mailing Address
First Line	:	19635 40TH PL NE
Second Line	:
City	:	LAKE FOREST PARK
State	:	WA
Zip	:	98155-2823
Country	:	US
Telephone Number	:	206-361-9229
Fax Number	:	206-366-0448

Provider Business Practice Location Address
First Line	:	19635 40TH PL NE
Second Line	:
City	:	LAKE FOREST PARK
State	:	WA
Zip	:	98155-2823
Country	:	US
Telephone Number	:	206-989-2100
Fax Number	:	206-366-0448

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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