Individual
ELLEN I JAEDICKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT, NCTMB, AA
Contact information
Practice address
137 SANDY BOTTOM RD, COVENTRY, RI 02816-5865
(401) 822-3676
(401) 826-1127
Mailing address
137 SANDY BOTTOM RD, COVENTRY, RI 02816-5865
(401) 822-3676
(401) 826-1127
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
01498
RI
Other
Enumeration date
04/13/2009
Last updated
04/13/2009
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