MEDICARE: LAURA MCINTOSH 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	3586	NE

General Provider Information

NPI Number	:	1184283434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MCINTOSH LMT

Provider Business Mailing Address
First Line	:	1306 CEDARWOODS DR
Second Line	:
City	:	PAPILLION
State	:	NE
Zip	:	68046-4730
Country	:	US
Telephone Number	:	402-499-9702
Fax Number	:

Provider Business Practice Location Address
First Line	:	4649 S 136TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68137-1101
Country	:	US
Telephone Number	:	402-499-9702
Fax Number	:

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

Provider Enumeration Date	:	06/11/2019
Last Update Date	:	06/11/2019

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Directions to “ LAURA MCINTOSH LMT” Practice Location

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