MEDICARE: THERESA MARIE MAYO 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	MA00010921	WA

General Provider Information

NPI Number	:	1952435547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA MARIE MAYO LMP

Provider Business Mailing Address
First Line	:	3302 FUHRMAN AVE E STE 110
Second Line	:	SUITE 110
City	:	SEATTLE
State	:	WA
Zip	:	98102-7115
Country	:	US
Telephone Number	:	206-402-4012
Fax Number	:	206-588-0795

Provider Business Practice Location Address
First Line	:	3302 FUHRMAN AVE E STE 110
Second Line	:	SUITE 110
City	:	SEATTLE
State	:	WA
Zip	:	98102-7115
Country	:	US
Telephone Number	:	206-402-4012
Fax Number	:	206-588-0795

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	03/14/2014

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