MEDICARE: JESSECA A MAGLOTHIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT-04475P	AZ

General Provider Information

NPI Number	:	1023399979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSECA A MAGLOTHIN

Provider Business Mailing Address
First Line	:	8113 W PRESTON LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-5430
Country	:	US
Telephone Number	:	623-428-9811
Fax Number	:

Provider Business Practice Location Address
First Line	:	8113 W PRESTON LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-5430
Country	:	US
Telephone Number	:	623-428-9811
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	09/06/2011

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Directions to “ JESSECA A MAGLOTHIN ” Practice Location

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