Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1003293135 |
---|---|
Provider Name | Mrs. Jaclyn W Ayotte |
First Address | East Greenwich, RI 02818-2116 |
Second Address | East Greenwich, RI 02818-2116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2015 |
Last Update Date | 27/04/2015 |