Provider Demographics
NPI:1235769548
Name:CATHEY, JENNIFER (LMT, MMT, NKT, MLD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:CATHEY
Suffix:
Gender:F
Credentials:LMT, MMT, NKT, MLD
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:STROER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 WRIGLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-7297
Mailing Address - Country:US
Mailing Address - Phone:618-789-4686
Mailing Address - Fax:
Practice Address - Street 1:103 WRIGLEY BLVD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-7297
Practice Address - Country:US
Practice Address - Phone:618-789-4686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-26
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227017115225700000X
SC11594225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty