MEDICARE: ALLEN MICHAEL WOOD ATC

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	225500000X	Respiratory/Developmental/Rehabilitative Specialist/Technologist

General Provider Information

NPI Number	:	1376586784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLEN MICHAEL WOOD ATC

Provider Business Mailing Address
First Line	:	13585 SW TARLETON CT
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97224-1678
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13585 SW TARLETON CT
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97224-1678
Country	:	US
Telephone Number	:	503-524-9666
Fax Number	:

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/08/2007

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