Individual
JESSICA NICHOLE SHARP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
42568 FOY CEMETERY RD, PONCHATOULA, LA 70454-5800
(985) 981-6012
Mailing address
42568 FOY CEMETARY, PONCHATOULA, LA 70454
(985) 981-6012
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
4429
LA
Other
Enumeration date
04/01/2010
Last updated
04/01/2010
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