MEDICARE: ALYSSA MARIE SPECHT

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	12163	OR

General Provider Information

NPI Number	:	1023341310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA MARIE SPECHT

Provider Business Mailing Address
First Line	:	7286 NE SHALEEN ST
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97124-9410
Country	:	US
Telephone Number	:	503-735-5436
Fax Number	:

Provider Business Practice Location Address
First Line	:	10395 NW GLENCOE RD
Second Line	:	SUITE 400
City	:	NORTH PLAINS
State	:	OR
Zip	:	97133-8208
Country	:	US
Telephone Number	:	503-647-0719
Fax Number	:

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

Provider Enumeration Date	:	09/17/2009
Last Update Date	:	09/17/2009

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Directions to “ ALYSSA MARIE SPECHT ” Practice Location

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