Provider Demographics
NPI:1285952739
Name:WRAITH, JENNIFER ANN (LMT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:WRAITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SHERIDAN AVE APT 54
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2750
Mailing Address - Country:US
Mailing Address - Phone:808-989-0449
Mailing Address - Fax:
Practice Address - Street 1:1301 SHERIDAN AVE APT 54
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2750
Practice Address - Country:US
Practice Address - Phone:808-989-0449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48919225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist