Provider Demographics
NPI:1881211498
Name:POWERS, JESSICA ELAINE (LMT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ELAINE
Last Name:POWERS
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:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:MT
Mailing Address - Zip Code:59313-0567
Mailing Address - Country:US
Mailing Address - Phone:406-853-1290
Mailing Address - Fax:
Practice Address - Street 1:228 SENATOR ST
Practice Address - Street 2:228 SENATOR ST. EKALAKA
Practice Address - City:EKALAKA
Practice Address - State:MT
Practice Address - Zip Code:59324
Practice Address - Country:US
Practice Address - Phone:406-853-1290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-13807225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist