MEDICARE: MS. JACLYN A. COLE 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	0009129	CO

General Provider Information

NPI Number	:	1619594066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACLYN A. COLE LMT

Provider Business Mailing Address
First Line	:	1035 PEARL ST STE 214
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-5130
Country	:	US
Telephone Number	:	720-237-4282
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 PEARL ST STE 214
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-5130
Country	:	US
Telephone Number	:	720-237-4282
Fax Number	:

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

Provider Enumeration Date	:	07/01/2020
Last Update Date	:	07/01/2020

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