MEDICARE: MARY ELIZABETH LANNING 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	18241	OR

General Provider Information

NPI Number	:	1881010254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH LANNING LMT

Provider Business Mailing Address
First Line	:	3818 SE 13TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-3815
Country	:	US
Telephone Number	:	503-329-1130
Fax Number	:

Provider Business Practice Location Address
First Line	:	3818 SE 13TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-3815
Country	:	US
Telephone Number	:	503-329-1130
Fax Number	:

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

Provider Enumeration Date	:	03/10/2014
Last Update Date	:	03/10/2014

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