MEDICARE: ANGELA KATHRYN DIRKERS 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	MT6847	ME

General Provider Information

NPI Number	:	1992386783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA KATHRYN DIRKERS LMT

Provider Business Mailing Address
First Line	:	PO BOX 216
Second Line	:
City	:	STRATTON
State	:	ME
Zip	:	04982-0216
Country	:	US
Telephone Number	:	435-602-3077
Fax Number	:

Provider Business Practice Location Address
First Line	:	241 BLACK POINT RD
Second Line	:
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-9356
Country	:	US
Telephone Number	:	435-602-3077
Fax Number	:

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

Provider Enumeration Date	:	04/14/2021
Last Update Date	:	04/14/2021

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