MEDICARE: MRS. JEANESE HAYWARD

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	27707	FL

General Provider Information

NPI Number	:	1821276098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEANESE HAYWARD

Provider Business Mailing Address
First Line	:	6025 PAIGE POINT DR
Second Line	:
City	:	MILTON
State	:	FL
Zip	:	32570-7763
Country	:	US
Telephone Number	:	850-748-7145
Fax Number	:

Provider Business Practice Location Address
First Line	:	6025 PAIGE POINT DR
Second Line	:
City	:	MILTON
State	:	FL
Zip	:	32570-7763
Country	:	US
Telephone Number	:	850-748-7145
Fax Number	:

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

Provider Enumeration Date	:	02/09/2008
Last Update Date	:	02/09/2008

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