Healthcare Provider Details

I. General information

NPI: 1952270571
Provider Name (Legal Business Name): JENNIFER M DRAPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1172 REID HOOKER N
EADS TN
38028-8026
US

IV. Provider business mailing address

1172 REID HOOKER N
EADS TN
38028-8026
US

V. Phone/Fax

Practice location:
  • Phone: 562-881-7451
  • Fax:
Mailing address:
  • Phone: 562-881-7451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number15761
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: