Provider Demographics
NPI:1093540114
Name:MONTEIRO, JESSICA (LMT, CMLDT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MONTEIRO
Suffix:
Gender:F
Credentials:LMT, CMLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 CAMPBELL AVE UNIT 201
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-7796
Mailing Address - Country:US
Mailing Address - Phone:914-690-4064
Mailing Address - Fax:
Practice Address - Street 1:589 CAMPBELL AVE UNIT 201
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-7796
Practice Address - Country:US
Practice Address - Phone:914-690-4064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11193225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist