Provider Demographics
NPI:1790101855
Name:BELANGER, JESSICA J (LMT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:J
Last Name:BELANGER
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 1:6 BLUE RD
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04259-6901
Mailing Address - Country:US
Mailing Address - Phone:207-933-3330
Mailing Address - Fax:
Practice Address - Street 1:6 BLUE RD
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04259-6901
Practice Address - Country:US
Practice Address - Phone:207-933-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT4438225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist