Provider Demographics
NPI:1275738163
Name:HOULE, JENNIFER MOSS (LMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MOSS
Last Name:HOULE
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 1:7 DEPOT STREET
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540
Mailing Address - Country:US
Mailing Address - Phone:706-698-4002
Mailing Address - Fax:706-698-4005
Practice Address - Street 1:7 DEPOT STREET
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540
Practice Address - Country:US
Practice Address - Phone:706-698-4002
Practice Address - Fax:706-698-4005
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT001421247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other