Individual provider · Type 1 NPI
Elizabeth A. Jackson, LIC. MASSAGE THERAPI
Specialist · Portland, ME
NPI number
1104091784
Active
Practice location
94 Auburn St Ste 106
Portland, ME 04103-2141
Fax (207) 878-3004
Mailing address
94 Auburn St, Suite 106
Portland, ME 04103-2141
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Specialist Primary | 174400000X | MT3127 (ME) |
Specialist: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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About NPI 1104091784
Elizabeth A. Jackson, LIC. MASSAGE THERAPI's National Provider Identifier is 1104091784, issued on Apr 24, 2008. The primary taxonomy on file is Specialist (174400000X), and the practice location is in Portland, ME. The record was last updated on Dec 8, 2008.