MEDICARE: PAIGE ROBINSON LMT, NCBTMB

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	174400000X	Specialist	16796	OR

General Provider Information

NPI Number	:	1962787341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAIGE ROBINSON LMT, NCBTMB

Provider Business Mailing Address
First Line	:	1232 NW MILWAUKEE AVE
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-2209
Country	:	US
Telephone Number	:	541-728-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1232 NW MILWAUKEE AVE
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-2209
Country	:	US
Telephone Number	:	541-728-4400
Fax Number	:

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

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	10/17/2011

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