MEDICARE: TRENIA O'DELL-GIFFORD 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	2005-1890	WV

General Provider Information

NPI Number	:	1477097640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRENIA O'DELL-GIFFORD LMT

Provider Business Mailing Address
First Line	:	PO BOX 496
Second Line	:
City	:	SAINT ALBANS
State	:	WV
Zip	:	25177-0496
Country	:	US
Telephone Number	:	304-421-5953
Fax Number	:

Provider Business Practice Location Address
First Line	:	2227 KANAWHA TER
Second Line	:
City	:	SAINT ALBANS
State	:	WV
Zip	:	25177-3186
Country	:	US
Telephone Number	:	304-421-5953
Fax Number	:

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

Provider Enumeration Date	:	12/07/2016
Last Update Date	:	12/07/2016

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