MEDICARE: MRS. JEANNE LYNN BRICKLEY 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	13240	OR

General Provider Information

NPI Number	:	1871791848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEANNE LYNN BRICKLEY L.M.T.

Provider Business Mailing Address
First Line	:	2080 SE OAK GROVE BLVD
Second Line	:	SUITE 13
City	:	MILWAUKIE
State	:	OR
Zip	:	97267-2657
Country	:	US
Telephone Number	:	503-803-3319
Fax Number	:

Provider Business Practice Location Address
First Line	:	2080 SE OAK GROVE BLVD
Second Line	:	SUITE 13
City	:	MILWAUKIE
State	:	OR
Zip	:	97267-2657
Country	:	US
Telephone Number	:	503-803-3319
Fax Number	:

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

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	07/10/2007

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