MEDICARE: SUZANNE SCHEVENE 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	9618	OR
2	225700000X	Massage Therapist	MA00007742	WA

General Provider Information

NPI Number	:	1174679971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE SCHEVENE LMT

Provider Business Mailing Address
First Line	:	811 W 11TH ST
Second Line	:
City	:	THE DALLES
State	:	OR
Zip	:	97058-1121
Country	:	US
Telephone Number	:	541-993-2847
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 WASHINGTON ST
Second Line	:	2B
City	:	THE DALLES
State	:	OR
Zip	:	97058-2262
Country	:	US
Telephone Number	:	541-993-2847
Fax Number	:

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/08/2007

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Directions to “ SUZANNE SCHEVENE LMT” Practice Location

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