=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780291997
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANETTE L SCHULTZ MASSAGE THERAPIST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2020
-----------------------------------------------------
Last Update Date | 09/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1854 LAUREL AVE
-----------------------------------------------------
City | BUNNELL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32110-4591
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-225-1949
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1854 LAUREL AVE
-----------------------------------------------------
City | BUNNELL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32110-4591
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-225-1949
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | OTA10881
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA93192
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------