Healthcare Provider Details

I. General information

NPI: 1104345123
Provider Name (Legal Business Name): JEANNA MARIE SNYDER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 09/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 HILL RD N
PICKERINGTON OH
43147-1310
US

IV. Provider business mailing address

2445 COLUMBUS LANCASTER RD NW LOT 343
LANCASTER OH
43130-5705
US

V. Phone/Fax

Practice location:
  • Phone: 614-632-2992
  • Fax:
Mailing address:
  • Phone: 740-777-8088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.023359
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: