MEDICARE: DARLENE MEYERS 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	2001013912	MO
2	225700000X	Massage Therapist	2017025446	MO
3	225700000X	Massage Therapist	2013034802	MO
4	225700000X	Massage Therapist	2002009212	MO

General Provider Information

NPI Number	:	1215401633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARLENE MEYERS LMT

Provider Business Mailing Address
First Line	:	PO BOX 2161
Second Line	:
City	:	BRANSON WEST
State	:	MO
Zip	:	65737-2161
Country	:	US
Telephone Number	:	417-272-1464
Fax Number	:

Provider Business Practice Location Address
First Line	:	11016 E STATE HIGHWAY 76 STE 21
Second Line	:
City	:	BRANSON WEST
State	:	MO
Zip	:	65737-9775
Country	:	US
Telephone Number	:	417-272-1464
Fax Number	:

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

Provider Enumeration Date	:	01/18/2019
Last Update Date	:	01/18/2019

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