MEDICARE: MRS. ELLEN FISCHLER GAUBA 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	0000013913	TN

General Provider Information

NPI Number	:	1609645100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELLEN FISCHLER GAUBA LMT

Provider Business Mailing Address
First Line	:	9239 LAWFORD WAY APT 207
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-5002
Country	:	US
Telephone Number	:	310-617-7045
Fax Number	:

Provider Business Practice Location Address
First Line	:	9325 APISON PIKE STE 137
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-3805
Country	:	US
Telephone Number	:	310-617-7045
Fax Number	:

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

Provider Enumeration Date	:	12/26/2023
Last Update Date	:	12/26/2023

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