Provider Demographics
NPI:1851857825
Name:POWELL, JAIME DANIELLE (LMT)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:DANIELLE
Last Name:POWELL
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 1:945 HARMONY LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-3419
Mailing Address - Country:US
Mailing Address - Phone:919-448-7503
Mailing Address - Fax:
Practice Address - Street 1:190 OAK ST APT 4
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1886
Practice Address - Country:US
Practice Address - Phone:919-448-7503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21678225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist