MEDICARE: HOPE CAMMACK 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	13068	OR

General Provider Information

NPI Number	:	1194409573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOPE CAMMACK LMT

Provider Business Mailing Address
First Line	:	2367 STATE ST STE 100
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-4505
Country	:	US
Telephone Number	:	503-568-2854
Fax Number	:

Provider Business Practice Location Address
First Line	:	2367 STATE ST STE 100
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-4505
Country	:	US
Telephone Number	:	503-568-2854
Fax Number	:

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

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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Directions to “ HOPE CAMMACK LMT” Practice Location

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