MEDICARE: MRS. KIMBERLY SUEZANNE NELSON 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	172M00000X	Mechanotherapist	5144	OR

General Provider Information

NPI Number	:	1518157924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY SUEZANNE NELSON L.M.T.

Provider Business Mailing Address
First Line	:	4220 SHASTA WAY
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-4842
Country	:	US
Telephone Number	:	541-892-5500
Fax Number	:

Provider Business Practice Location Address
First Line	:	4220 SHASTA WAY
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-4842
Country	:	US
Telephone Number	:	541-892-5500
Fax Number	:

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

Provider Enumeration Date	:	07/31/2007
Last Update Date	:	01/07/2015

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