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General NPI Number Information
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NPI Number | 1669982278
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Entity Type | Individual
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Provider Name | JESSICA G TOLLIVER LMT, MMT
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Gender | Female
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Dates
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Enumeration Date | 10/09/2017
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 400 W CAPITOL AVE STE 2848
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City | LITTLE ROCK
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State | AR
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Zip | 72201-3415
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Country | US
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Telephone | 501-650-9014
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Fax | 501-712-3075
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Provider Business Mailing Address
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Address Line | 21009 EDDIE RD
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City | HENSLEY
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State | AR
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Zip | 72065-8065
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Country | US
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Telephone | 501-650-9014
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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 | 8115
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License Number State | AR
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