Individual
JESSICA MICKELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS, CNIM, LMT
Contact information
Practice address
13440 PARKER COMMONS BLVD STE 103, FORT MYERS, FL 33912-1816
(239) 671-0695
Mailing address
9720 GLADIOLUS PRESERVE CIR, FORT MYERS, FL 33908-9720
(239) 671-0695
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA92171
FL
Other
Enumeration date
06/03/2020
Last updated
06/03/2020
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