MEDICARE: JACQUELINE MARY LINDER LMT CNMT

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	MA13971	FL

General Provider Information

NPI Number	:	1205950151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE MARY LINDER LMT CNMT

Provider Business Mailing Address
First Line	:	PO BOX 1124
Second Line	:
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-1124
Country	:	US
Telephone Number	:	727-793-9177
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 4TH AVE S
Second Line	:
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-4020
Country	:	US
Telephone Number	:	727-793-9177
Fax Number	:

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

Provider Enumeration Date	:	03/18/2007
Last Update Date	:	05/29/2008

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