MEDICARE: MRS. ERICA LOUISE DUNSMORE 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	171W00000X	Contractor	LMT #11649	OR

General Provider Information

NPI Number	:	1568887040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERICA LOUISE DUNSMORE LMT

Provider Business Mailing Address
First Line	:	525 GLEN CREEK RD NW
Second Line	:	SUITE 230
City	:	SALEM
State	:	OR
Zip	:	97304-3161
Country	:	US
Telephone Number	:	503-339-7376
Fax Number	:	503-217-0364

Provider Business Practice Location Address
First Line	:	525 GLEN CREEK RD NW
Second Line	:	SUITE 230
City	:	SALEM
State	:	OR
Zip	:	97304-3161
Country	:	US
Telephone Number	:	503-339-7376
Fax Number	:	503-217-0364

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

Provider Enumeration Date	:	02/20/2014
Last Update Date	:	02/20/2014

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