Provider Demographics
NPI:1902537293
Name:LEMON, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LEMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WALDEN PINE CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-3969
Mailing Address - Country:US
Mailing Address - Phone:919-696-3861
Mailing Address - Fax:
Practice Address - Street 1:5300 EAST DR
Practice Address - Street 2:
Practice Address - City:ARBUTUS
Practice Address - State:MD
Practice Address - Zip Code:21227-2669
Practice Address - Country:US
Practice Address - Phone:443-492-9861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-18
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12251225700000X
MDR02381225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist