MEDICARE: REBECCA (BECKY) L CAMPBELL LMT, NMT

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	019535	OH

General Provider Information

NPI Number	:	1831512805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA (BECKY) L CAMPBELL LMT, NMT

Provider Business Mailing Address
First Line	:	1930 N LIMESTONE ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45503-2648
Country	:	US
Telephone Number	:	937-390-6403
Fax Number	:	937-390-2673

Provider Business Practice Location Address
First Line	:	1930 N LIMESTONE ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45503-2648
Country	:	US
Telephone Number	:	937-390-6403
Fax Number	:	937-390-2673

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

Provider Enumeration Date	:	01/28/2014
Last Update Date	:	01/28/2014

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