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General NPI Number Information
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NPI Number | 1699243816
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Entity Type | Individual
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Provider Name | CAREY JENNIFER WACKER LMT
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Gender | Female
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Dates
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Enumeration Date | 11/06/2018
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Last Update Date | 11/06/2018
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Provider Practice Location Address
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Address Line | 500 GEORGE ST
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City | HANOVER
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State | PA
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Zip | 17331-1452
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Country | US
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Telephone | 717-632-8211
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Fax |
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Provider Business Mailing Address
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Address Line | 315 BROADWAY CARRIAGE HOUSE
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City | HANOVER
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State | PA
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Zip | 17331
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Country | US
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Telephone | 717-521-7038
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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 | MSG012465
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License Number State | PA
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