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NPI Code Detail

MEDICARE: ANNA WANDELL LMT

MEDICARE:   ANNA  WANDELL  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
1225700000XMassage Therapist27172OR

General Provider Information

NPI Number : 1235847856
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA WANDELL LMT
Provider Business Mailing Address
First Line : 2343 SE TUALATIN VALLEY HWY
Second Line :
City : HILLSBORO
State : OR
Zip : 97123-7976
Country : US
Telephone Number : 971-245-3034
Fax Number :
Provider Business Practice Location Address
First Line : 2343 SE TUALATIN VALLEY HWY
Second Line :
City : HILLSBORO
State : OR
Zip : 97123-7976
Country : US
Telephone Number : 971-245-3034
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2022
Last Update Date : 04/15/2024

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Directions to “ ANNA WANDELL LMT” Practice Location

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