MEDICARE: GAIL ANN WELLS

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	3408	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	921399	OTHER	NY	WORKERS COMP AND NO-FAULT

General Provider Information

NPI Number	:	1306253158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL ANN WELLS

Provider Business Mailing Address
First Line	:	2 NORMANSKILL BLVD
Second Line	:
City	:	DELMAR
State	:	NY
Zip	:	12054-1331
Country	:	US
Telephone Number	:	518-475-9456
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 NORMANSKILL BLVD
Second Line	:
City	:	DELMAR
State	:	NY
Zip	:	12054-1331
Country	:	US
Telephone Number	:	518-475-9456
Fax Number	:

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

Provider Enumeration Date	:	07/14/2014
Last Update Date	:	07/14/2014

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Directions to “ GAIL ANN WELLS ” Practice Location

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