MEDICARE: MISS NATASHA DAUGHERTY LMT

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	15902	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15902	OTHER	OR	LMT

General Provider Information

NPI Number	:	1255845913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NATASHA DAUGHERTY LMT

Provider Business Mailing Address
First Line	:	1110 18TH ST
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-4200
Country	:	US
Telephone Number	:	541-297-0182
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 18TH ST
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-4200
Country	:	US
Telephone Number	:	541-297-0182
Fax Number	:

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

Provider Enumeration Date	:	11/16/2017
Last Update Date	:	03/17/2018

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