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General NPI Number Information
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NPI Number | 1144588450
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Entity Type | Individual
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Provider Name | JESSICA JENSINE NOLES M.T.
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Gender | Female
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Dates
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Enumeration Date | 04/25/2012
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 24781 5 MILE RD # 103
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City | REDFORD
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State | MI
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Zip | 48239-3632
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Country | US
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Telephone | 313-739-3731
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Fax |
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Provider Business Mailing Address
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Address Line | 8275 CLOVERLAWN ST
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City | DETROIT
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State | MI
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Zip | 48204-3227
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Country | US
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Telephone | 313-739-3374
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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 | 7501007560
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | MI
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