MEDICARE: AMANDA NELSON 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	174400000X	Specialist	13898	OR

General Provider Information

NPI Number	:	1447451034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA NELSON LMT

Provider Business Mailing Address
First Line	:	559 GLATT CIR STE 1
Second Line	:
City	:	WOODBURN
State	:	OR
Zip	:	97071-9675
Country	:	US
Telephone Number	:	503-981-4591
Fax Number	:	503-982-3308

Provider Business Practice Location Address
First Line	:	559 GLATT CIR STE 1
Second Line	:
City	:	WOODBURN
State	:	OR
Zip	:	97071-9675
Country	:	US
Telephone Number	:	503-981-4591
Fax Number	:	503-982-3308

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/08/2007

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