Provider Demographics
NPI:1336486562
Name:BRICE, JENNIFER RENAE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RENAE
Last Name:BRICE
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 1:1303 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-7705
Mailing Address - Country:US
Mailing Address - Phone:417-818-2661
Mailing Address - Fax:
Practice Address - Street 1:1303 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-7705
Practice Address - Country:US
Practice Address - Phone:417-818-2661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005032221225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist