MEDICARE: TAMMARA L. MCGOVERN 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	MA 60214532	WA

General Provider Information

NPI Number	:	1952692105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMARA L. MCGOVERN LMP

Provider Business Mailing Address
First Line	:	1212 N WASHINGTON ST
Second Line	:	SUITE 114
City	:	SPOKANE
State	:	WA
Zip	:	99201-2403
Country	:	US
Telephone Number	:	509-951-7289
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 N WASHINGTON ST
Second Line	:	SUITE 114
City	:	SPOKANE
State	:	WA
Zip	:	99201-2403
Country	:	US
Telephone Number	:	509-951-7289
Fax Number	:

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

Provider Enumeration Date	:	04/22/2011
Last Update Date	:	10/04/2012

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