MEDICARE: AUTUMN GONZALEZ-BELCHER 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	2015-3335	WV

General Provider Information

NPI Number	:	1710356480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN GONZALEZ-BELCHER LMT

Provider Business Mailing Address
First Line	:	213 DUSTY MILLER ST
Second Line	:
City	:	PRINCETON
State	:	WV
Zip	:	24740-7666
Country	:	US
Telephone Number	:	304-910-9880
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 NEW HOPE RD
Second Line	:
City	:	PRINCETON
State	:	WV
Zip	:	24740-2135
Country	:	US
Telephone Number	:	304-910-9880
Fax Number	:

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

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	01/05/2021

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