MEDICARE: MISS MEAGHAN REBECCA BULL 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	16469	OR

General Provider Information

NPI Number	:	1578082384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MEAGHAN REBECCA BULL LMT

Provider Business Mailing Address
First Line	:	125 NW GEORGIA AVE
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-2821
Country	:	US
Telephone Number	:	541-517-1603
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 NW GEORGIA AVE
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-2821
Country	:	US
Telephone Number	:	541-517-1603
Fax Number	:

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

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	07/21/2022

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