MEDICARE: CENTRAL OREGON LYMPHEDEMA AND

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1346954294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL OREGON LYMPHEDEMA AND

Provider Business Mailing Address
First Line	:	2669 NE TWIN KNOLLS DR STE 104
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-4895
Country	:	US
Telephone Number	:	541-241-0223
Fax Number	:

Provider Business Practice Location Address
First Line	:	2669 NE TWIN KNOLLS DR STE 104
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-4895
Country	:	US
Telephone Number	:	541-241-0223
Fax Number	:

Authorized Official
Title or Position	:	PT/OWNDER
Name	:	MELISSA FOLEY CARLTON
Credential	:	PT
Telephone Number	:	541-241-0223

Provider Enumeration Date	:	01/05/2023
Last Update Date	:	01/05/2023

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