Provider Demographics
NPI:1023617313
Name:JEFFERIS, MAKAYLA (LMT)
Entity type:Individual
Prefix:MS
First Name:MAKAYLA
Middle Name:
Last Name:JEFFERIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12464 LAUREL HILL RD
Mailing Address - Street 2:
Mailing Address - City:THORNVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43076-9380
Mailing Address - Country:US
Mailing Address - Phone:330-524-6491
Mailing Address - Fax:
Practice Address - Street 1:409 S 22ND ST STE 5
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1575
Practice Address - Country:US
Practice Address - Phone:740-564-3022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2024-02-21
Deactivation Date:2021-08-22
Deactivation Code:
Reactivation Date:2024-02-09
Provider Licenses
StateLicense IDTaxonomies
OH33.025187225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist