MEDICARE: ROSEANNE LAWRENCE

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	21823	OR

General Provider Information

NPI Number	:	1932644879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEANNE LAWRENCE

Provider Business Mailing Address
First Line	:	3610 SW GROVER ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97221-4120
Country	:	US
Telephone Number	:	503-522-8740
Fax Number	:

Provider Business Practice Location Address
First Line	:	3610 SW GROVER ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97221-4120
Country	:	US
Telephone Number	:	503-522-8740
Fax Number	:

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

Provider Enumeration Date	:	01/02/2017
Last Update Date	:	10/17/2017

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Directions to “ ROSEANNE LAWRENCE ” Practice Location

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