MEDICARE: EMALIE REID

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	27415	OR

General Provider Information

NPI Number	:	1629755046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMALIE REID

Provider Business Mailing Address
First Line	:	PO BOX 448
Second Line	:
City	:	WILLIAMS
State	:	OR
Zip	:	97544-0448
Country	:	US
Telephone Number	:	541-514-6405
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 SE H ST
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-3025
Country	:	US
Telephone Number	:	541-415-6405
Fax Number	:

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

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	06/28/2023

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Directions to “ EMALIE REID ” Practice Location

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