Provider Demographics
NPI:1063724334
Name:KAUFFMAN-MARINELLI, JANE BRADLEY
Entity type:Individual
Prefix:MR
First Name:JANE
Middle Name:BRADLEY
Last Name:KAUFFMAN-MARINELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:BRADLEY
Other - Last Name:KAUFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:711 W. 40TH STREET
Mailing Address - Street 2:SUITE 316
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211
Mailing Address - Country:US
Mailing Address - Phone:443-386-2054
Mailing Address - Fax:
Practice Address - Street 1:711 W. 40TH STREET
Practice Address - Street 2:SUITE 316
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211
Practice Address - Country:US
Practice Address - Phone:443-386-2054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM00306225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist