Individual
JENNIFER L COSTILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1823 W STATE ST, FREMONT, OH 43420-1635
(419) 334-7737
(419) 334-2528
Mailing address
1823 W STATE ST, FREMONT, OH 43420-1635
(419) 334-7737
(419) 334-2528
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
12817
OH
Other
Enumeration date
03/30/2007
Last updated
07/08/2007
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