MEDICARE: JASMINE JOEL

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	13650	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13650	OTHER	OR	OREGON BOARD OF MASSAGE THERAPISTS

General Provider Information

NPI Number	:	1447757588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE JOEL

Provider Business Mailing Address
First Line	:	5695 HOOD ST
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-3235
Country	:	US
Telephone Number	:	503-915-0191
Fax Number	:

Provider Business Practice Location Address
First Line	:	5695 HOOD ST
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-3235
Country	:	US
Telephone Number	:	503-915-0191
Fax Number	:

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

Provider Enumeration Date	:	04/06/2018
Last Update Date	:	04/06/2018

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Directions to “ JASMINE JOEL ” Practice Location

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