MEDICARE: MS. JAIME M IRVING LMT, LAC

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	11116-146	WI
2	171100000X	Acupuncturist	744-55	WI

General Provider Information

NPI Number	:	1427392331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAIME M IRVING LMT, LAC

Provider Business Mailing Address
First Line	:	4001 NAKOOSA TRL STE 203
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53714-1381
Country	:	US
Telephone Number	:	608-213-3664
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 NAKOOSA TRL
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53714-1379
Country	:	US
Telephone Number	:	608-285-9000
Fax Number	:

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

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	04/06/2026

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