MEDICARE: KALEY PATTERSON 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	12837	OR

General Provider Information

NPI Number	:	1598925950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALEY PATTERSON LMT

Provider Business Mailing Address
First Line	:	10200 N MCALISTER RD
Second Line	:
City	:	ISLAND CITY
State	:	OR
Zip	:	97850-8723
Country	:	US
Telephone Number	:	541-963-7435
Fax Number	:

Provider Business Practice Location Address
First Line	:	10200 N MCALISTER RD
Second Line	:
City	:	ISLAND CITY
State	:	OR
Zip	:	97850-8723
Country	:	US
Telephone Number	:	541-963-7435
Fax Number	:

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

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	06/15/2011

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