MEDICARE: MRS. JANEEN LATRICE HENDERSON 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	33.022840	OH

General Provider Information

NPI Number	:	1235593922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANEEN LATRICE HENDERSON LMT

Provider Business Mailing Address
First Line	:	17325 EUCLID AVE STE 4037
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44112-1247
Country	:	US
Telephone Number	:	843-995-5531
Fax Number	:

Provider Business Practice Location Address
First Line	:	17325 EUCLID AVE STE 4037
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44112-1247
Country	:	US
Telephone Number	:	843-995-5531
Fax Number	:

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

Provider Enumeration Date	:	04/08/2016
Last Update Date	:	08/20/2020

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