MEDICARE: MS. JESSICA NICOLE SEYDEL CMT

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

General Provider Information

NPI Number	:	1174843148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA NICOLE SEYDEL CMT

Provider Business Mailing Address
First Line	:	918 N 18TH ST
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-0331
Country	:	US
Telephone Number	:	406-697-6596
Fax Number	:

Provider Business Practice Location Address
First Line	:	670 KING PARK DR STE 1
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-6257
Country	:	US
Telephone Number	:	406-655-4940
Fax Number	:

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

Provider Enumeration Date	:	06/01/2010
Last Update Date	:	06/01/2010

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