Healthcare Provider Details

I. General information

NPI: 1396816872
Provider Name (Legal Business Name): JESSICA ALLEN CHEW LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 OLD HWY 431 SUITE C
HAMPTON COVE AL
35763
US

IV. Provider business mailing address

7910 MEMORIAL PKWY SW SUITE F2
HUNTSVILLE AL
35802-2260
US

V. Phone/Fax

Practice location:
  • Phone: 256-533-3443
  • Fax:
Mailing address:
  • Phone: 256-489-5118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1722
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: