Doctor Name: | ELLEN I JAEDICKE |
NPI Number: | 1285877811 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMT, NCTMB, AA |
License Number: | 01498 |
Business Practice Address: | 137 Sandy Bottom Rd Coventry, RI - 028165865 |
Business Phone Number: | 4018223676 |
Business Fax Number: | 4018261127 |
Mailing Address: | 137 Sandy Bottom Rd, COVENTRY |
State: | RI |
Postal Code: | 028165865 |
Phone Number: | 4018223676 |
Fax Number: | 4018261127 |
NPI Enumeration Date: | 04/13/2009 |
NPI Last Update Date: | 04/13/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 01498 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | RI |
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. |