MEDICARE: MARIZA NOYAMA-ZEE 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	172M00000X	Mechanotherapist	12720	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12720	OTHER		OREGON LICENSED MASSAGE THERAPIST

General Provider Information

NPI Number	:	1740714963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIZA NOYAMA-ZEE LMT

Provider Business Mailing Address
First Line	:	6516 SE 92ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97266-5236
Country	:	US
Telephone Number	:	971-221-9312
Fax Number	:

Provider Business Practice Location Address
First Line	:	6516 SE 92ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97266-5236
Country	:	US
Telephone Number	:	971-221-9312
Fax Number	:

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

Provider Enumeration Date	:	04/13/2017
Last Update Date	:	04/13/2017

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