Provider Demographics
NPI:1841635372
Name:BEAL, JENNIFER L (LMT MMP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BEAL
Suffix:
Gender:F
Credentials:LMT MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-9732
Mailing Address - Country:US
Mailing Address - Phone:413-977-3672
Mailing Address - Fax:
Practice Address - Street 1:43 OLIVER ST
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-9732
Practice Address - Country:US
Practice Address - Phone:413-977-3672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8733225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist