Provider Demographics
NPI:1013504877
Name:CALDWELL KER, JOLIE (MT)
Entity type:Individual
Prefix:
First Name:JOLIE
Middle Name:
Last Name:CALDWELL KER
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 TIERRA REJADA RD UNIT 78
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2918
Mailing Address - Country:US
Mailing Address - Phone:805-539-3879
Mailing Address - Fax:
Practice Address - Street 1:195 TIERRA REJADA RD UNIT 78
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2918
Practice Address - Country:US
Practice Address - Phone:805-539-3879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2878225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist