Healthcare Provider Details

I. General information

NPI: 1538565999
Provider Name (Legal Business Name): JENNIFER M HUTSON L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STAFFORD LN UNIT 30217
DELTA CO
81416-2256
US

IV. Provider business mailing address

17586 2550 RD
CEDAREDGE CO
81413
US

V. Phone/Fax

Practice location:
  • Phone: 970-361-8014
  • Fax:
Mailing address:
  • Phone: 970-361-8014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.001749
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: