MEDICARE: EMILY SIMPSON 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	174400000X	Specialist	18634	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1255683231	OTHER	OR	LMT

General Provider Information

NPI Number	:	1255683231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY SIMPSON LMT

Provider Business Mailing Address
First Line	:	1842 NW 25TH AVE STE A
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-2568
Country	:	US
Telephone Number	:	503-206-9087
Fax Number	:

Provider Business Practice Location Address
First Line	:	1842 NW 25TH AVE STE A
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-2568
Country	:	US
Telephone Number	:	503-206-9087
Fax Number	:

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

Provider Enumeration Date	:	10/15/2012
Last Update Date	:	04/23/2019

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Directions to “ EMILY SIMPSON LMT” Practice Location

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