MEDICARE: AMANDA OBERHEU CMT

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	NOT REQUIRED IN MICH	MI

General Provider Information

NPI Number	:	1578835765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA OBERHEU CMT

Provider Business Mailing Address
First Line	:	201 1/2 E GRAND RIVER AVE
Second Line	:	SUITE 19
City	:	EAST LANSING
State	:	MI
Zip	:	48823-4323
Country	:	US
Telephone Number	:	517-203-1113
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 1/2 E GRAND RIVER AVE
Second Line	:	SUITE 19
City	:	EAST LANSING
State	:	MI
Zip	:	48823-4323
Country	:	US
Telephone Number	:	517-203-1113
Fax Number	:

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

Provider Enumeration Date	:	02/02/2012
Last Update Date	:	02/02/2012

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