MEDICARE: KIMBERLY ERICKSON 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	23569	OR

General Provider Information

NPI Number	:	1073261384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ERICKSON LMT

Provider Business Mailing Address
First Line	:	15000 SW BARROWS RD STE 202
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97007-8778
Country	:	US
Telephone Number	:	503-489-7278
Fax Number	:	503-446-3362

Provider Business Practice Location Address
First Line	:	15000 SW BARROWS RD STE 202
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97007-8778
Country	:	US
Telephone Number	:	503-489-7278
Fax Number	:	503-446-3362

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

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	03/15/2022

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Directions to “ KIMBERLY ERICKSON LMT” Practice Location

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