MEDICARE: MRS. ALLYSON SUZANNE WESSELLS PT, IBCLC

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	174N00000X	Lactation Consultant (Non-RN)	L-58094	OH
2	225100000X	Physical Therapist	008993	OH

General Provider Information

NPI Number	:	1649661430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALLYSON SUZANNE WESSELLS PT, IBCLC

Provider Business Mailing Address
First Line	:	2268 NORTHWEST BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-3821
Country	:	US
Telephone Number	:	740-710-1378
Fax Number	:

Provider Business Practice Location Address
First Line	:	2268 NORTHWEST BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-3821
Country	:	US
Telephone Number	:	740-710-1378
Fax Number	:

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

Provider Enumeration Date	:	02/15/2015
Last Update Date	:	02/16/2015

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