MEDICARE: JEVAE CHRISHAUN COLLINS 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	2009028949	MO

General Provider Information

NPI Number	:	1952944555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEVAE CHRISHAUN COLLINS LMT

Provider Business Mailing Address
First Line	:	12013 E 47TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-2517
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12013 E 47TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-2517
Country	:	US
Telephone Number	:	816-433-6411
Fax Number	:

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

Provider Enumeration Date	:	10/26/2019
Last Update Date	:	10/26/2019

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