Healthcare Provider Details

I. General information

NPI: 1982483129
Provider Name (Legal Business Name): JACQUELINE MARIE DEYOE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 MONMOUTH ST
NEWPORT KY
41071-1821
US

IV. Provider business mailing address

407 HAWTHORNE AVE
CINCINNATI OH
45205-2225
US

V. Phone/Fax

Practice location:
  • Phone: 859-322-8135
  • Fax:
Mailing address:
  • Phone: 859-322-8135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number260408
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: