MEDICARE: TAMARA TRAVERS AMENDOLARE 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	MA00012982	WA

General Provider Information

NPI Number	:	1790511764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA TRAVERS AMENDOLARE LMT

Provider Business Mailing Address
First Line	:	3818 S AIRPORT RD
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98363-8458
Country	:	US
Telephone Number	:	509-423-3475
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 E 1ST ST STE E
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-4323
Country	:	US
Telephone Number	:	509-423-3475
Fax Number	:

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

Provider Enumeration Date	:	09/09/2024
Last Update Date	:	09/09/2024

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