MEDICARE: MRS. ALICIA MARIE COLLINS 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	33.011834	OH

General Provider Information

NPI Number	:	1598953002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALICIA MARIE COLLINS L.M.T.

Provider Business Mailing Address
First Line	:	5144 PANHANDLE RD
Second Line	:
City	:	NEW VIENNA
State	:	OH
Zip	:	45159-9428
Country	:	US
Telephone Number	:	927-364-9322
Fax Number	:

Provider Business Practice Location Address
First Line	:	5144 PANHANDLE RD
Second Line	:
City	:	NEW VIENNA
State	:	OH
Zip	:	45159-9428
Country	:	US
Telephone Number	:	927-364-9322
Fax Number	:

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

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

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