MEDICARE: JESSICA MAE VANNATTER 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	9580	NM

General Provider Information

NPI Number	:	1033864897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MAE VANNATTER LMT

Provider Business Mailing Address
First Line	:	530 HIGHWAY 180 W
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-4400
Country	:	US
Telephone Number	:	575-956-6171
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 HIGHWAY 180 W
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-4400
Country	:	US
Telephone Number	:	575-956-6171
Fax Number	:

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

Provider Enumeration Date	:	02/18/2022
Last Update Date	:	02/18/2022

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Directions to “ JESSICA MAE VANNATTER LMT” Practice Location

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