Provider Demographics
NPI:1093996688
Name:KINCAID, MARY JENNEY (NMLMT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JENNEY
Last Name:KINCAID
Suffix:
Gender:F
Credentials:NMLMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3643 WEBBER ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-4412
Mailing Address - Country:US
Mailing Address - Phone:941-921-5569
Mailing Address - Fax:
Practice Address - Street 1:3643 WEBBER ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-4412
Practice Address - Country:US
Practice Address - Phone:941-921-5569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-25
Last Update Date:2007-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0020867225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist