MEDICARE: MISS TASHA MARIE MCDANIELS L.M.T

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	12820	OR

General Provider Information

NPI Number	:	1578790911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TASHA MARIE MCDANIELS L.M.T

Provider Business Mailing Address
First Line	:	10120 SE WAVERLY CT
Second Line	:	# 63
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-7438
Country	:	US
Telephone Number	:	503-753-4857
Fax Number	:

Provider Business Practice Location Address
First Line	:	10120 SE WAVERLY CT
Second Line	:	# 63
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-7438
Country	:	US
Telephone Number	:	503-753-4857
Fax Number	:

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

Provider Enumeration Date	:	06/12/2009
Last Update Date	:	01/21/2016

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