Provider Demographics
NPI:1003293135
Name:AYOTTE, JACLYN W (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:W
Last Name:AYOTTE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:JACLYN
Other - Middle Name:G
Other - Last Name:WEITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:5873 POST RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-2116
Mailing Address - Country:US
Mailing Address - Phone:401-203-1069
Mailing Address - Fax:
Practice Address - Street 1:5873 POST RD
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-2116
Practice Address - Country:US
Practice Address - Phone:401-203-1069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist