MEDICARE: ALISON COLLEEN KENNEDY 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	60270885	WA

General Provider Information

NPI Number	:	1962758276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON COLLEEN KENNEDY LMP

Provider Business Mailing Address
First Line	:	3902 SW SOUTHERN ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-2342
Country	:	US
Telephone Number	:	206-923-8766
Fax Number	:

Provider Business Practice Location Address
First Line	:	6017 CALIFORNIA AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-1612
Country	:	US
Telephone Number	:	206-923-8766
Fax Number	:

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

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	04/03/2017

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