MEDICARE: LAUREN WALES

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	374J00000X	Doula
2	225700000X	Massage Therapist	33.015501	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33.015501	OTHER	OH	OHIO MEDICAL BOARD - LIMITED BRANCH MASSAGE LICENSE

General Provider Information

NPI Number	:	1891298667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN WALES

Provider Business Mailing Address
First Line	:	548 BURR OAK ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45232-1718
Country	:	US
Telephone Number	:	513-886-6439
Fax Number	:

Provider Business Practice Location Address
First Line	:	5011 KENWOOD RD STE 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45227-2040
Country	:	US
Telephone Number	:	513-886-6439
Fax Number	:

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

Provider Enumeration Date	:	03/17/2018
Last Update Date	:	03/17/2018

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Directions to “ LAUREN WALES ” Practice Location

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