Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | 017425 | NY |
NPI | 1013137454 |
---|---|
Provider Name | Mrs. Jenniffer Marie Mace |
First Address | Cheektowaga, NY 14215-2007 |
Second Address | Amherst, NY 14226-1738 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 08/07/2007 |