MEDICARE: AMANDA JANAY BARBER MASSAGE THERAPIST

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	172V00000X	Community Health Worker	60263717	WA

General Provider Information

NPI Number	:	1104203876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA JANAY BARBER MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	717 NE 61ST ST
Second Line	:	#100
City	:	VANCOUVER
State	:	WA
Zip	:	98665-8753
Country	:	US
Telephone Number	:	503-974-6463
Fax Number	:

Provider Business Practice Location Address
First Line	:	717 NE 61ST ST
Second Line	:	#100
City	:	VANCOUVER
State	:	WA
Zip	:	98665-8753
Country	:	US
Telephone Number	:	503-974-6463
Fax Number	:

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

Provider Enumeration Date	:	05/01/2015
Last Update Date	:	05/01/2015

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