Healthcare Provider Details

I. General information

NPI: 1699174110
Provider Name (Legal Business Name): JENNIFER CAWLEY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RICHMOND SQ SUITE 307E
PROVIDENCE RI
02906-5139
US

IV. Provider business mailing address

PO BOX 24
SOMERSET MA
02726-0024
US

V. Phone/Fax

Practice location:
  • Phone: 401-261-4241
  • Fax:
Mailing address:
  • Phone: 401-261-4241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT00928
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6535
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: