MEDICARE: MRS. ARNITA ELAINE MAXWELL 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	10238

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10238	OTHER	OR	MASSAGE THERAPY

General Provider Information

NPI Number	:	1083884209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ARNITA ELAINE MAXWELL LMT

Provider Business Mailing Address
First Line	:	3245 TRIANGLE DR S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302
Country	:	US
Telephone Number	:	503-363-2922
Fax Number	:	503-364-4576

Provider Business Practice Location Address
First Line	:	3245 TRIANGLE DR S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302
Country	:	US
Telephone Number	:	503-363-2922
Fax Number	:	503-364-4576

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

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	03/04/2008

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