MEDICARE: MS. SIOMARA YANILET JACOBO 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	MA49679	FL

General Provider Information

NPI Number	:	1841413580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SIOMARA YANILET JACOBO LMT

Provider Business Mailing Address
First Line	:	3131 W OAK RIDGE RD
Second Line	:	BLDG 117
City	:	ORLANDO
State	:	FL
Zip	:	32809
Country	:	US
Telephone Number	:	321-297-1713
Fax Number	:

Provider Business Practice Location Address
First Line	:	1936 LEE ROAD
Second Line	:	STE 137 MARC IRWIN SHARFMAN MD PA
City	:	WINTER PARK
State	:	FL
Zip	:	32789
Country	:	US
Telephone Number	:	407-644-3737
Fax Number	:	407-644-3009

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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