MEDICARE: TERIAH LENICE WILSON 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	MT118459	TX

General Provider Information

NPI Number	:	1538931977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERIAH LENICE WILSON LMT

Provider Business Mailing Address
First Line	:	10811 RICHMOND AVE APT 88
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-4767
Country	:	US
Telephone Number	:	713-428-8515
Fax Number	:

Provider Business Practice Location Address
First Line	:	10811 RICHMOND AVE APT 88
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-4767
Country	:	US
Telephone Number	:	713-428-8515
Fax Number	:

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

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	10/30/2023

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Directions to “ TERIAH LENICE WILSON LMT” Practice Location

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