Provider Demographics
NPI:1205247632
Name:JESTER, TABITHA
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:JESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 POND RD
Mailing Address - Street 2:
Mailing Address - City:TITUS
Mailing Address - State:AL
Mailing Address - Zip Code:36080-4521
Mailing Address - Country:US
Mailing Address - Phone:334-224-9617
Mailing Address - Fax:
Practice Address - Street 1:135 1ST ST
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-3923
Practice Address - Country:US
Practice Address - Phone:334-320-0371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3096225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist