Healthcare Provider Details

I. General information

NPI: 1194999193
Provider Name (Legal Business Name): JACQUELYN MARIE HUFF LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HARRIS AVE
PORTLAND ME
04103-1531
US

IV. Provider business mailing address

110 HARRIS AVE
PORTLAND ME
04103-1531
US

V. Phone/Fax

Practice location:
  • Phone: 207-878-8803
  • Fax: 207-878-8803
Mailing address:
  • Phone: 207-878-8803
  • Fax: 207-878-8803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT1995
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: