MEDICARE: WENDY ANNE MYERSLMT 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	33.017262	OH

General Provider Information

NPI Number	:	1174759096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY ANNE MYERSLMT LMT

Provider Business Mailing Address
First Line	:	533 WILTSHIRE BLVD APT D
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45419-1446
Country	:	US
Telephone Number	:	937-409-3627
Fax Number	:

Provider Business Practice Location Address
First Line	:	4770 WILMINGTON PIKE
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45440-2021
Country	:	US
Telephone Number	:	937-409-3627
Fax Number	:	397-433-2884

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

Provider Enumeration Date	:	06/05/2009
Last Update Date	:	06/05/2009

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