MEDICARE: MR. SCOTT ROBERT DOLAN L.M.T

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	13385	OR

General Provider Information

NPI Number	:	1457624132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT ROBERT DOLAN L.M.T

Provider Business Mailing Address
First Line	:	15211 S KIRK RD
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-8775
Country	:	US
Telephone Number	:	971-533-5436
Fax Number	:

Provider Business Practice Location Address
First Line	:	729 MOLALLA AVE
Second Line	:	SUITE #4
City	:	OREGON CITY
State	:	OR
Zip	:	97045-2654
Country	:	US
Telephone Number	:	971-533-5436
Fax Number	:

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

Provider Enumeration Date	:	02/11/2012
Last Update Date	:	02/11/2012

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