Provider Demographics
NPI:1568854719
Name:WOOD, JESSICA (CMT, RMT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:CMT, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-8820
Mailing Address - Country:US
Mailing Address - Phone:970-946-9456
Mailing Address - Fax:
Practice Address - Street 1:40031 US HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122-8746
Practice Address - Country:US
Practice Address - Phone:970-884-2455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16024225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist