MEDICARE: MS. ELIZABETH DOTY L.M.T.

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	18951	OR

General Provider Information

NPI Number	:	1801133079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH DOTY L.M.T.

Provider Business Mailing Address
First Line	:	2179 NW HOYT ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-3214
Country	:	US
Telephone Number	:	503-732-0237
Fax Number	:

Provider Business Practice Location Address
First Line	:	1722 NW RALEIGH ST
Second Line	:	SUITE 423
City	:	PORTLAND
State	:	OR
Zip	:	97209-1753
Country	:	US
Telephone Number	:	503-732-0237
Fax Number	:

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

Provider Enumeration Date	:	01/08/2013
Last Update Date	:	01/08/2013

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