Provider Demographics
NPI:1871714246
Name:MACE, JAIMEE LEE (MSPT)
Entity type:Individual
Prefix:MRS
First Name:JAIMEE
Middle Name:LEE
Last Name:MACE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:JAIMEE
Other - Middle Name:
Other - Last Name:OTTALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:148 EASTWAY
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-1109
Mailing Address - Country:US
Mailing Address - Phone:781-413-4214
Mailing Address - Fax:
Practice Address - Street 1:148 EASTWAY
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-1109
Practice Address - Country:US
Practice Address - Phone:781-413-4214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist