MEDICARE: SAVANNA VIRGINIA OLLER 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	26371	OR

General Provider Information

NPI Number	:	1649840471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNA VIRGINIA OLLER LMT

Provider Business Mailing Address
First Line	:	11451 SW DAVIES RD APT 1812
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97007-8316
Country	:	US
Telephone Number	:	425-445-5821
Fax Number	:

Provider Business Practice Location Address
First Line	:	15000 SW BARROWS RD STE 202
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97007-8778
Country	:	US
Telephone Number	:	503-489-7278
Fax Number	:

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

Provider Enumeration Date	:	06/24/2021
Last Update Date	:	06/24/2021

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