MEDICARE: MS. JACQUELINE KEENAN KINCAID L.M.T.

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	MA13932	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568538643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELINE KEENAN KINCAID L.M.T.

Provider Business Mailing Address
First Line	:	4781 N CONGRESS AVE
Second Line	:	#186
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-7941
Country	:	US
Telephone Number	:	561-389-4377
Fax Number	:	561-292-2155

Provider Business Practice Location Address
First Line	:	7950 S MILITARY TRL
Second Line	:	SUITE 103
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-8162
Country	:	US
Telephone Number	:	561-389-4377
Fax Number	:	561-292-2155

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	12/20/2011

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