MEDICARE: KEYNE WEBB

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	173C00000X	Reflexologist	19629	OR

General Provider Information

NPI Number	:	1396140448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYNE WEBB

Provider Business Mailing Address
First Line	:	12208 NW BARNES RD APT 223
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-6024
Country	:	US
Telephone Number	:	503-628-9333
Fax Number	:

Provider Business Practice Location Address
First Line	:	12208 NW BARNES RD APT 223
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-6024
Country	:	US
Telephone Number	:	503-628-9333
Fax Number	:

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

Provider Enumeration Date	:	10/31/2014
Last Update Date	:	10/31/2014

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Directions to “ KEYNE WEBB ” Practice Location

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