MEDICARE: MR. ISAAC GRANT SLAUGHTER 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	13303	OR

General Provider Information

NPI Number	:	1629125224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ISAAC GRANT SLAUGHTER LMT

Provider Business Mailing Address
First Line	:	15915 S BOULDER DR
Second Line	:
City	:	MULINO
State	:	OR
Zip	:	97042-9755
Country	:	US
Telephone Number	:	503-545-8303
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 7TH ST
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-2346
Country	:	US
Telephone Number	:	503-545-8303
Fax Number	:

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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