MEDICARE: SIOBHAN MEAGAN LANE 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	022978-1	NY

General Provider Information

NPI Number	:	1447560909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIOBHAN MEAGAN LANE LMT

Provider Business Mailing Address
First Line	:	365 HARRY L DR
Second Line	:	STE. C AND D
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-1471
Country	:	US
Telephone Number	:	607-644-2823
Fax Number	:	607-238-1556

Provider Business Practice Location Address
First Line	:	365 HARRY L DR
Second Line	:	STE. C AND D
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-1471
Country	:	US
Telephone Number	:	607-644-2823
Fax Number	:	607-238-1556

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

Provider Enumeration Date	:	10/18/2010
Last Update Date	:	10/18/2010

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Directions to “ SIOBHAN MEAGAN LANE LMT” Practice Location

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