Provider Demographics
NPI:1386285393
Name:CACCHILLO, JANE ANN (LMT)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ANN
Last Name:CACCHILLO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:ANN
Other - Last Name:CACCHILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:35 CAPISTRANO DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-2105
Mailing Address - Country:US
Mailing Address - Phone:386-301-2349
Mailing Address - Fax:
Practice Address - Street 1:35 CAPISTRANO DR
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-2105
Practice Address - Country:US
Practice Address - Phone:386-301-2349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA89432225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist