MEDICARE: TAMMY J STILL 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	12077	OR

General Provider Information

NPI Number	:	1245673144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY J STILL LMT

Provider Business Mailing Address
First Line	:	1701 W HARVARD AVE STE 204
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-2716
Country	:	US
Telephone Number	:	541-430-1748
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 W HARVARD AVE
Second Line	:	SUITE 204
City	:	ROSEBURG
State	:	OR
Zip	:	97471-2716
Country	:	US
Telephone Number	:	541-430-1748
Fax Number	:

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

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	04/10/2013

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