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NPI Code Detail

MEDICARE: LILY ANDERSON LMT

MEDICARE: LILY ANDERSON 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
1225700000XMassage Therapist25387OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
125387OTHERORSTATE OF OREGON

General Provider Information

NPI Number : 1740830579
Entity Type Code : Individual
Provider Name (Legal Business Name) : LILY ANDERSON LMT
Provider Business Mailing Address
First Line : 2214 NE MCDONALD LN
Second Line :
City : MCMINNVILLE
State : OR
Zip : 97128-2702
Country : US
Telephone Number : 503-434-6603
Fax Number : 503-434-6746
Provider Business Practice Location Address
First Line : 2214 NE MCDONALD LN
Second Line :
City : MCMINNVILLE
State : OR
Zip : 97128-2702
Country : US
Telephone Number : 503-434-6603
Fax Number : 503-434-6746
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2019
Last Update Date : 09/13/2019

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Directions to “ LILY ANDERSON LMT” Practice Location

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