MEDICARE: MRS. JESSICA ANN GOUSHA LMT

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	KY-2732	KY

General Provider Information

NPI Number	:	1194042564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA ANN GOUSHA LMT

Provider Business Mailing Address
First Line	:	131 FINLEY RD
Second Line	:
City	:	WINCHESTER
State	:	KY
Zip	:	40391-1734
Country	:	US
Telephone Number	:	859-749-5111
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 W. LEXINGTON AVE.
Second Line	:
City	:	WINCHESTER
State	:	KY
Zip	:	40391-1116
Country	:	US
Telephone Number	:	859-744-5353
Fax Number	:

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

Provider Enumeration Date	:	04/26/2010
Last Update Date	:	09/22/2011

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