MEDICARE: CASSANDRA NICOLE BERECZKY 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	33.026112	OH

General Provider Information

NPI Number	:	1538879234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA NICOLE BERECZKY LMT

Provider Business Mailing Address
First Line	:	7935 W NATIONAL RD
Second Line	:
City	:	NEW CARLISLE
State	:	OH
Zip	:	45344-8269
Country	:	US
Telephone Number	:	937-408-3027
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 E LAKE AVE
Second Line	:
City	:	NEW CARLISLE
State	:	OH
Zip	:	45344-1417
Country	:	US
Telephone Number	:	937-408-3027
Fax Number	:

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

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	04/18/2023

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Directions to “ CASSANDRA NICOLE BERECZKY LMT” Practice Location

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