MEDICARE: ELEMENTAL WELLNESS THERAPY

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1235991878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEMENTAL WELLNESS THERAPY

Provider Business Mailing Address
First Line	:	63368 SADDLEBACK DR
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-8566
Country	:	US
Telephone Number	:	541-390-1493
Fax Number	:

Provider Business Practice Location Address
First Line	:	63368 SADDLEBACK DR
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-8566
Country	:	US
Telephone Number	:	541-390-1493
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TANIA KNEUER
Credential	:	OT
Telephone Number	:	541-390-1493

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	01/29/2024

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Directions to “ELEMENTAL WELLNESS THERAPY ” Practice Location

Language	Start Address	Practice Location

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