MEDICARE: MR. JEFFREY E BAZE 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	5222	OR

General Provider Information

NPI Number	:	1386811511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY E BAZE LMT

Provider Business Mailing Address
First Line	:	3245 TRIANGLE DR SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4505
Country	:	US
Telephone Number	:	503-363-2922
Fax Number	:

Provider Business Practice Location Address
First Line	:	3245 TRIANGLE DR SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4505
Country	:	US
Telephone Number	:	503-363-2922
Fax Number	:

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

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	05/15/2008

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