Provider Demographics
NPI:1780438663
Name:OLIVEIRA, JERNICE ANDRADE I (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:JERNICE
Middle Name:ANDRADE
Last Name:OLIVEIRA
Suffix:I
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:531 PLEASENT STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:508-559-1577
Mailing Address - Fax:508-559-5144
Practice Address - Street 1:531 PLEASENT STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-559-1577
Practice Address - Fax:508-559-5144
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA17209225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist