MEDICARE: TAMLA C WATERS CAMPBELL 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	MT0479	DC

General Provider Information

NPI Number	:	1902386766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMLA C WATERS CAMPBELL LMT

Provider Business Mailing Address
First Line	:	16405 VILLAGE DR W
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-3246
Country	:	US
Telephone Number	:	202-630-3550
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 CONNECTICUT AVE NW STE 1
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20008-4500
Country	:	US
Telephone Number	:	202-630-3550
Fax Number	:

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

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	08/20/2018

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