MEDICARE: MELINDA G APODACA 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	11539	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11539	OTHER	OR	STATE LICENSE

General Provider Information

NPI Number	:	1053359521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA G APODACA LMT

Provider Business Mailing Address
First Line	:	1880 WILLAMETTE FALLS DR STE 260
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-4654
Country	:	US
Telephone Number	:	503-701-7714
Fax Number	:	503-594-8948

Provider Business Practice Location Address
First Line	:	1880 WILLAMETTE FALLS DR STE 260
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-4654
Country	:	US
Telephone Number	:	503-701-7714
Fax Number	:	503-594-8948

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	02/24/2023

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Directions to “ MELINDA G APODACA LMT” Practice Location

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