MEDICARE: EMILY SIMPSON 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	225700000X	Massage Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1255683231	OTHER		NPI

General Provider Information

NPI Number	:	1912561184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMILY SIMPSON LMT

Provider Business Mailing Address
First Line	:	1842 NW 25TH AVE STE A
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-2568
Country	:	US
Telephone Number	:	503-206-9087
Fax Number	:

Provider Business Practice Location Address
First Line	:	1842 NW 25TH AVE STE A
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-2568
Country	:	US
Telephone Number	:	503-206-9087
Fax Number	:

Authorized Official
Title or Position	:	OWNER/LMT
Name	:	EMILY SIMPSON
Credential	:	LMT
Telephone Number	:	503-206-9087

Provider Enumeration Date	:	04/23/2019
Last Update Date	:	06/11/2019

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Directions to “EMILY SIMPSON LMT ” Practice Location

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