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General NPI Number Information
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NPI Number | 1992946479
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Entity Type | Individual
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Provider Name | MISS JESSICA CUPPY
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Gender | Female
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Dates
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Enumeration Date | 03/13/2009
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Last Update Date | 03/13/2009
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Provider Practice Location Address
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Address Line | 1435 SE 8TH TER STE D
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City | CAPE CORAL
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State | FL
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Zip | 33990-3289
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Country | US
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Telephone | 239-573-4235
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Fax |
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Provider Business Mailing Address
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Address Line | 3625 PELICAN BLVD
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City | CAPE CORAL
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State | FL
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Zip | 33914-5830
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Country | US
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Telephone |
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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 | MA52577
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License Number State | FL
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