Healthcare Provider Details

I. General information

NPI: 1861904781
Provider Name (Legal Business Name): ANDREA JO MAYBEE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA JO MAYBEE LMT

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 E MAIN ST
GOWANDA NY
14070-1208
US

IV. Provider business mailing address

9795 POINT PETER RD
GOWANDA NY
14070-9636
US

V. Phone/Fax

Practice location:
  • Phone: 716-289-3899
  • Fax:
Mailing address:
  • Phone: 716-289-3899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number020970
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: