MEDICARE: MRS. TAMI BRIANNA WADE LMT 3708-146

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	3708-146	WI

General Provider Information

NPI Number	:	1073780243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMI BRIANNA WADE LMT 3708-146

Provider Business Mailing Address
First Line	:	620 E GREEN BAY AVE STE 104
Second Line	:
City	:	SAUKVILLE
State	:	WI
Zip	:	53080-2039
Country	:	US
Telephone Number	:	262-284-0022
Fax Number	:	855-798-9891

Provider Business Practice Location Address
First Line	:	620 E GREEN BAY AVE STE 104
Second Line	:
City	:	SAUKVILLE
State	:	WI
Zip	:	53080-2039
Country	:	US
Telephone Number	:	262-284-0022
Fax Number	:	855-798-9891

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

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	09/22/2023

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