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NPI Code Detail

MEDICARE: MICHELE HISLOP BA, QMHA, LMT

MEDICARE: MICHELE HISLOP BA, QMHA, 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
1171M00000XCase Manager/Care Coordinator
2225700000XMassage Therapist10968OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110968OTHERORLISENCED MASSAGE THERAPIS

General Provider Information

NPI Number : 1366645731
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELE HISLOP BA, QMHA, LMT
Provider Business Mailing Address
First Line : 633 NE 8TH ST
Second Line :
City : MCMINNVILLE
State : OR
Zip : 97128-3911
Country : US
Telephone Number : 503-560-0446
Fax Number :
Provider Business Practice Location Address
First Line : 435 NE EVANS ST
Second Line :
City : MCMINNVILLE
State : OR
Zip : 97128-4628
Country : US
Telephone Number : 503-472-4020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2007
Last Update Date : 09/18/2019

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