MEDICARE: LAURA SYLVIA MACKIE 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	60240324	WA
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1932387701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA SYLVIA MACKIE LMP

Provider Business Mailing Address
First Line	:	5898 N FORK RD
Second Line	:
City	:	DEMING
State	:	WA
Zip	:	98244-9518
Country	:	US
Telephone Number	:	360-820-4060
Fax Number	:

Provider Business Practice Location Address
First Line	:	8251 KENDALL RD.
Second Line	:
City	:	MAPLE FALLS
State	:	WA
Zip	:	98266
Country	:	US
Telephone Number	:	360-820-4060
Fax Number	:

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

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	12/28/2011

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