MEDICARE: MRS. JENNIFER CARROLL KEHOE

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	20917	OR

General Provider Information

NPI Number	:	1922758572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER CARROLL KEHOE

Provider Business Mailing Address
First Line	:	324 N 7TH ST
Second Line	:
City	:	SAINT HELENS
State	:	OR
Zip	:	97051-1416
Country	:	US
Telephone Number	:	971-225-0076
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 COLUMBIA BLVD
Second Line	:
City	:	SAINT HELENS
State	:	OR
Zip	:	97051-6220
Country	:	US
Telephone Number	:	971-225-0076
Fax Number	:

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

Provider Enumeration Date	:	03/26/2022
Last Update Date	:	03/26/2022

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