Active NPI
Ellen I Jaedicke, LMT, NCTMB, AA
- Massage Therapist
- Coventry, RI
National Provider Identifier
1285877811
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 01498
- Practice address
- 137 Sandy Bottom Rd
Coventry, RI 02816-5865 - Phone
- (401) 822-3676
- Fax
- (401) 826-1127
- NPI assigned
- Apr 13, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 01498 | RI | Primary |
Addresses
Primary practice location
137 Sandy Bottom Rd
Coventry, RI 02816-5865
Mailing address
137 Sandy Bottom Rd
Coventry, RI 02816-5865
Phone (401) 822-3676
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Associate of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01498 | RI | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Four Winds Chiropractic, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239580800000",
"number": "1285877811",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "137 SANDY BOTTOM RD",
"city": "COVENTRY",
"state": "RI",
"postal_code": "028165865",
"telephone_number": "401-822-3676",
"fax_number": "401-826-1127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "137 SANDY BOTTOM RD",
"city": "COVENTRY",
"state": "RI",
"postal_code": "028165865",
"telephone_number": "401-822-3676",
"fax_number": "401-826-1127"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAEDICKE",
"first_name": "ELLEN",
"middle_name": "I",
"credential": "LMT, NCTMB, AA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-04-13",
"last_updated": "2009-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "RI",
"license": "01498",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coventry, RI
- Jennifer Houle
- Lori A Houle, COTA/L
- Linda Hunnicutt, LMT
- Karen A. Hynes, LMT
- Jamie Michele Italiane-Decubellis, DDS
- Jamie Italiane-Decubellis DDS and Assoc. Inc
- Jacques Ira Jewell, LCSW
- Joanne C. Lewis Pediatric Dentistry, LLC (Children's Dentistry of Coventry)
- Kristin Jollie, M.A.
- Lori A. Jones, MSW, LICSW
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.