MEDICARE: INTERMISSION MASSAGE STUDIO

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

General Provider Information

NPI Number	:	1427757822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERMISSION MASSAGE STUDIO

Provider Business Mailing Address
First Line	:	1880 WILLAMETTE FALLS DR STE 260
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-4654
Country	:	US
Telephone Number	:	503-701-7714
Fax Number	:

Provider Business Practice Location Address
First Line	:	1880 WILLAMETTE FALLS DR STE 260
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-4654
Country	:	US
Telephone Number	:	503-701-7714
Fax Number	:

Authorized Official
Title or Position	:	OWNER/LICENSED MASSAGE THERAPIST
Name	:	MELINDA G APODACA
Credential	:	LMT
Telephone Number	:	503-701-7714

Provider Enumeration Date	:	02/24/2023
Last Update Date	:	02/24/2023

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Directions to “INTERMISSION MASSAGE STUDIO ” Practice Location

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