MEDICARE: MARIE MOREAU 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	MA77952	FL

General Provider Information

NPI Number	:	1831860998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE MOREAU LMT

Provider Business Mailing Address
First Line	:	4630 S KIRKMAN RD # 157
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-2833
Country	:	US
Telephone Number	:	407-815-5344
Fax Number	:

Provider Business Practice Location Address
First Line	:	4864 CYPRESS WOODS DR APT 305
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-3508
Country	:	US
Telephone Number	:	407-815-5344
Fax Number	:

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

Provider Enumeration Date	:	09/27/2021
Last Update Date	:	09/27/2021

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