MEDICARE: MICHEL EISENHOUR CMT

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	173C00000X	Reflexologist		OK
2	225700000X	Massage Therapist		OK

General Provider Information

NPI Number	:	1932414638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHEL EISENHOUR CMT

Provider Business Mailing Address
First Line	:	11709 BLUE SAGE RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-5903
Country	:	US
Telephone Number	:	405-413-9759
Fax Number	:

Provider Business Practice Location Address
First Line	:	2832 W WILSHIRE BLVD STE 101
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-4028
Country	:	US
Telephone Number	:	405-413-9759
Fax Number	:

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

Provider Enumeration Date	:	08/18/2010
Last Update Date	:	08/18/2010

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Directions to “ MICHEL EISENHOUR CMT” Practice Location

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