MEDICARE: ARLI WYNN 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	023264	OR

General Provider Information

NPI Number	:	1700353893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARLI WYNN LMT

Provider Business Mailing Address
First Line	:	3930 HIGH ST
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405-3949
Country	:	US
Telephone Number	:	907-343-9344
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 PEARL ST
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97401-4118
Country	:	US
Telephone Number	:	907-343-9344
Fax Number	:

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

Provider Enumeration Date	:	10/27/2018
Last Update Date	:	10/27/2018

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