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General NPI Number Information
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NPI Number | 1093050593
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Entity Type | Individual
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Provider Name | JODI MARIE MCCLAIN L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 12/10/2012
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 103 W CLAY AVE
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City | MUSKEGON
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State | MI
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Zip | 49440-1210
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Country | US
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Telephone | 231-670-9038
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Fax |
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Provider Business Mailing Address
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Address Line | 103 W CLAY AVE
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City | MUSKEGON
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State | MI
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Zip | 49440-1210
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Country | US
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Telephone | 231-670-9038
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA-8132
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 7501002413
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License Number State | MI
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