MEDICARE: MRS. AMANDA LYNN EGGLESTON 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	97035	CA
2	225700000X	Massage Therapist	MA61589836	WA

General Provider Information

NPI Number	:	1346088788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA LYNN EGGLESTON LMT

Provider Business Mailing Address
First Line	:	275 SE CABOT DR STE B207
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-3755
Country	:	US
Telephone Number	:	208-219-1001
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 SE CABOT DR STE B207
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-3755
Country	:	US
Telephone Number	:	564-676-5150
Fax Number	:

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

Provider Enumeration Date	:	07/18/2024
Last Update Date	:	04/07/2025

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