MEDICARE: NATALIE NELSON 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	12656	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750042909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE NELSON LMT

Provider Business Mailing Address
First Line	:	1703 TOMOKA DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-5907
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 SAINT ANDREWS BLVD STE A
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7196
Country	:	US
Telephone Number	:	443-465-9135
Fax Number	:

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

Provider Enumeration Date	:	01/09/2022
Last Update Date	:	01/09/2022

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