MEDICARE: JENNIFER LYNNE MATYN 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	7501010846	MI

General Provider Information

NPI Number	:	1215711502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNNE MATYN LMT

Provider Business Mailing Address
First Line	:	1965 OAK POINTE DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48306-2925
Country	:	US
Telephone Number	:	239-777-3044
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 W TIENKEN RD STE B
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48306-4404
Country	:	US
Telephone Number	:	239-777-3044
Fax Number	:

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

Provider Enumeration Date	:	08/21/2023
Last Update Date	:	08/21/2023

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