MEDICARE: GEORGE MEREDITH L.M.T.

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	13298	OR

General Provider Information

NPI Number	:	1578958476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE MEREDITH L.M.T.

Provider Business Mailing Address
First Line	:	17620 PILKINGTON RD
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-5361
Country	:	US
Telephone Number	:	503-636-2265
Fax Number	:	503-636-9862

Provider Business Practice Location Address
First Line	:	17620 PILKINGTON RD
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-5361
Country	:	US
Telephone Number	:	503-636-2265
Fax Number	:	503-636-9862

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

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	02/06/2026

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