MEDICARE: MRS. JESSICA SUSSMAN 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	22472	OR

General Provider Information

NPI Number	:	1336004084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA SUSSMAN LMT

Provider Business Mailing Address
First Line	:	2800 CROSBY AVE STE B
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-5700
Country	:	US
Telephone Number	:	541-205-3364
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 CROSBY AVE STE B
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-5700
Country	:	US
Telephone Number	:	541-205-3364
Fax Number	:

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

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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