Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 227.009621 | IL |
NPI | 1003233032 |
---|---|
Provider Name | Doris L Jeske |
First Address | Monee, IL 60449-9290 |
Second Address | New Lenox, IL 60451-1633 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2014 |
Last Update Date | 27/03/2014 |