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General NPI Number Information
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NPI Number | 1902537293
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Entity Type | Individual
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Provider Name | JESSICA LEMON
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Gender | Female
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Dates
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Enumeration Date | 06/18/2022
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Last Update Date | 06/18/2022
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Provider Practice Location Address
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Address Line | 5300 EAST DR
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City | ARBUTUS
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State | MD
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Zip | 21227-2669
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Country | US
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Telephone | 443-492-9861
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Fax |
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Provider Business Mailing Address
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Address Line | 12 WALDEN PINE CT
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City | BALTIMORE
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State | MD
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Zip | 21207-3969
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Country | US
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Telephone | 919-696-3861
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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 | 12251
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License Number State | NC
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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 | R02381
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License Number State | MD
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