MEDICARE: YVETTE MARIE WANCEL

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	MT014179	GA

General Provider Information

NPI Number	:	1093673477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVETTE MARIE WANCEL

Provider Business Mailing Address
First Line	:	730 GLENWOOD AVE SE APT 411
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-3576
Country	:	US
Telephone Number	:	407-463-9229
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 GLENWOOD AVE SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-3454
Country	:	US
Telephone Number	:	407-463-9229
Fax Number	:

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

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

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