MEDICARE: MRS. MELISSA DIANE SINCLAIR 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	11886	OR

General Provider Information

NPI Number	:	1780861435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA DIANE SINCLAIR LMT

Provider Business Mailing Address
First Line	:	2447 SE 70TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-1108
Country	:	US
Telephone Number	:	503-380-5588
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 NE 28TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-3300
Country	:	US
Telephone Number	:	503-245-5993
Fax Number	:

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

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	02/08/2008

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Directions to “ MRS. MELISSA DIANE SINCLAIR LMT” Practice Location

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