Doctor Name: | JESSICA RAE WYATT |
NPI Number: | 1033495338 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMT |
License Number: | 33.018202 |
Business Practice Address: | 36711 American Way Suite A Avon, OH - 440114062 |
Business Phone Number: | 4402254555 |
Business Fax Number: | |
Mailing Address: | 36711 American Way, Suite A AVON |
State: | OH |
Postal Code: | 440114062 |
Phone Number: | 4402254555 |
Fax Number: | |
NPI Enumeration Date: | 10/31/2011 |
NPI Last Update Date: | 10/31/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 33.018202 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |