MEDICARE: TRACY LYNN SNYDER

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	16104	OR

General Provider Information

NPI Number	:	1114250768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY LYNN SNYDER

Provider Business Mailing Address
First Line	:	1735 SNOWBIRD DR NW
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97304-2051
Country	:	US
Telephone Number	:	503-507-9334
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 CAPITOL ST NE STE A
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-1201
Country	:	US
Telephone Number	:	503-507-9334
Fax Number	:

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

Provider Enumeration Date	:	09/15/2009
Last Update Date	:	07/23/2012

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