Provider Demographics
NPI:1184008880
Name:JAGGERS, SAMANTHA NOEL (LMT)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:NOEL
Last Name:JAGGERS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 LAGRANGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:KY
Mailing Address - Zip Code:40050-6743
Mailing Address - Country:US
Mailing Address - Phone:502-321-5197
Mailing Address - Fax:
Practice Address - Street 1:525 LAGRANGE RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:KY
Practice Address - Zip Code:40050-6743
Practice Address - Country:US
Practice Address - Phone:502-321-5197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYBMTMTH00220860225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist