Provider Demographics
NPI:1417364118
Name:MASTERS, JESSICA JAYNE (LMT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JAYNE
Last Name:MASTERS
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 1:1680 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2306
Mailing Address - Country:US
Mailing Address - Phone:541-292-3281
Mailing Address - Fax:
Practice Address - Street 1:545 LIT WAY
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2401
Practice Address - Country:US
Practice Address - Phone:541-292-3281
Practice Address - Fax:541-708-6302
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17950225700000X, 172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist