Jennifer L Costilla, LMT

NPI #1114047495 in Fremont, Ohio

Provider Information

NPI Number: 1114047495
Entity Type: Individual
Name: Jennifer L Costilla, LMT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Massage Therapist
Credential: LMT
Enumeration Date: Mar 30, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 1823 W STATE ST
City: Fremont
State: Ohio
ZIP Code: 43420-1635
Phone: (419) 334-7737

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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