MEDICARE: JENNIFER MUELLER 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	18228	OR

General Provider Information

NPI Number	:	1407142730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MUELLER LMT

Provider Business Mailing Address
First Line	:	16083 SW UPPER BOONES FERRY RD
Second Line	:	SUITE 300
City	:	TIGARD
State	:	OR
Zip	:	97224-7736
Country	:	US
Telephone Number	:	800-219-8835
Fax Number	:	503-639-9699

Provider Business Practice Location Address
First Line	:	4437 SE CESAR E CHAVEZ BLVD
Second Line	:	SUITE C
City	:	PORTLAND
State	:	OR
Zip	:	97202-3581
Country	:	US
Telephone Number	:	503-774-3585
Fax Number	:	503-774-3602

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

Provider Enumeration Date	:	06/24/2011
Last Update Date	:	11/12/2012

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