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NPI Code Detail

MEDICARE: JON MARTIN SCHAEFFER

MEDICARE:   JON MARTIN SCHAEFFER
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
1225700000XMassage Therapist23475OR

General Provider Information

NPI Number : 1063029395
Entity Type Code : Individual
Provider Name (Legal Business Name) : JON MARTIN SCHAEFFER
Provider Business Mailing Address
First Line : 480 5TH ST
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97034-3079
Country : US
Telephone Number : 503-793-8676
Fax Number :
Provider Business Practice Location Address
First Line : 480 5TH ST
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97034-3079
Country : US
Telephone Number : 503-793-8676
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2020
Last Update Date : 06/28/2022

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Directions to “ JON MARTIN SCHAEFFER ” Practice Location

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