Provider Demographics
NPI:1417595349
Name:MCGUIRE, JACQUELINE (CMT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1127
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-1127
Mailing Address - Country:US
Mailing Address - Phone:209-601-2307
Mailing Address - Fax:
Practice Address - Street 1:1275 E F ST
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-4140
Practice Address - Country:US
Practice Address - Phone:209-601-2307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1329321225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist