MEDICARE: ANDREA LETT 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	174400000X	Specialist	22042	OR

General Provider Information

NPI Number	:	1720523012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA LETT LMT

Provider Business Mailing Address
First Line	:	4627 NE 30TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-7001
Country	:	US
Telephone Number	:	503-281-0681
Fax Number	:	503-335-6258

Provider Business Practice Location Address
First Line	:	4627 NE 30TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-7001
Country	:	US
Telephone Number	:	503-281-0681
Fax Number	:	503-335-6258

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

Provider Enumeration Date	:	12/22/2016
Last Update Date	:	12/22/2016

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Directions to “ ANDREA LETT LMT” Practice Location

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