Provider Demographics
NPI:1205338225
Name:SCHNEIDER, JAIME LYNN (MASSMA60558674)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:LYNN
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:MASSMA60558674
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:LYNN
Other - Last Name:BODVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 E MAPLE ST APT 506
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5172
Mailing Address - Country:US
Mailing Address - Phone:360-739-6803
Mailing Address - Fax:
Practice Address - Street 1:1209 11TH ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7078
Practice Address - Country:US
Practice Address - Phone:360-739-6803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMASS.MA60558674225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMASS.MA60558674OtherLMT