MEDICARE: LESLEY J MOEHLE BS., 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	13277	OR

General Provider Information

NPI Number	:	1245522770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLEY J MOEHLE BS., LMT

Provider Business Mailing Address
First Line	:	PO BOX 1002
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-0034
Country	:	US
Telephone Number	:	541-301-7449
Fax Number	:

Provider Business Practice Location Address
First Line	:	268 VAN NESS AVE
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-1736
Country	:	US
Telephone Number	:	541-301-7449
Fax Number	:

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

Provider Enumeration Date	:	05/02/2011
Last Update Date	:	04/30/2013

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