Provider Demographics
NPI:1033438403
Name:JAEGER, ANDREA LEE (CMT, CMMP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEE
Last Name:JAEGER
Suffix:
Gender:F
Credentials:CMT, CMMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 6410 CT
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81403-4483
Mailing Address - Country:US
Mailing Address - Phone:970-640-0207
Mailing Address - Fax:
Practice Address - Street 1:320 6410 CT
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81403-4483
Practice Address - Country:US
Practice Address - Phone:970-640-0207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4363225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4363OtherDORA