MEDICARE: MICHELLE A. VIESSELMAN LMT, NCTMB, MMP, CLT

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	NVMT-01	NV

General Provider Information

NPI Number	:	1528196698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE A. VIESSELMAN LMT, NCTMB, MMP, CLT

Provider Business Mailing Address
First Line	:	5830 W QUAIL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2746
Country	:	US
Telephone Number	:	702-643-1202
Fax Number	:	702-364-1475

Provider Business Practice Location Address
First Line	:	2860 E FLAMINGO RD
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5271
Country	:	US
Telephone Number	:	702-731-2128
Fax Number	:	866-378-3528

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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