MEDICARE: BLISS OUT WELLNESS LLC

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

General Provider Information

NPI Number	:	1144813619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLISS OUT WELLNESS LLC

Provider Business Mailing Address
First Line	:	707 NW HILL ST
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-2922
Country	:	US
Telephone Number	:	512-850-9178
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 NW HILL ST
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-2922
Country	:	US
Telephone Number	:	512-850-9178
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS OWNER
Name	:	BELINDA MARTINEZ
Credential	:	LMT
Telephone Number	:	512-850-9178

Provider Enumeration Date	:	02/16/2021
Last Update Date	:	02/16/2021

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Directions to “BLISS OUT WELLNESS LLC ” Practice Location

Language	Start Address	Practice Location

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