Healthcare Provider Details

I. General information

NPI: 1114244555
Provider Name (Legal Business Name): B. JAYNE SPAULDING LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6914 SHELBYVILLE RD
SIMPSONVILLE KY
40067-6510
US

IV. Provider business mailing address

50 KESSLER MILL RD
BAGDAD KY
40003-8063
US

V. Phone/Fax

Practice location:
  • Phone: 502-722-5003
  • Fax:
Mailing address:
  • Phone: 502-220-7414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberKY1983
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: