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NPI Code Detail

MEDICARE: CASSANDRA WILSON LMT

MEDICARE: CASSANDRA WILSON 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
1225700000XMassage Therapist27214OR

General Provider Information

NPI Number : 1881477990
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSANDRA WILSON LMT
Provider Business Mailing Address
First Line : 1744 HAMILTON LN
Second Line :
City : GRANTS PASS
State : OR
Zip : 97527-4702
Country : US
Telephone Number : 541-761-0017
Fax Number :
Provider Business Practice Location Address
First Line : 598 NE E ST STE C
Second Line :
City : GRANTS PASS
State : OR
Zip : 97526-2350
Country : US
Telephone Number : 541-761-0017
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2023
Last Update Date : 08/14/2023

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Directions to “ CASSANDRA WILSON LMT” Practice Location

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