MEDICARE: ALIX MICHELE MARMULSTEIN 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	24560	OR

General Provider Information

NPI Number	:	1669957296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALIX MICHELE MARMULSTEIN LMT

Provider Business Mailing Address
First Line	:	P.O. BOX 553
Second Line	:
City	:	WILLIAMS
State	:	OR
Zip	:	97544
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	598 NE E ST STE A
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-2350
Country	:	US
Telephone Number	:	541-819-0824
Fax Number	:

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

Provider Enumeration Date	:	09/28/2018
Last Update Date	:	11/12/2024

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Directions to “ ALIX MICHELE MARMULSTEIN LMT” Practice Location

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