Provider Demographics
NPI:1043557978
Name:GUILLET, LAETITIA MARIE-EMMANUELLE (LMT)
Entity Type:Individual
Prefix:MS
First Name:LAETITIA
Middle Name:MARIE-EMMANUELLE
Last Name:GUILLET
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 1:626 NW 4TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6549
Mailing Address - Country:US
Mailing Address - Phone:541-758-2016
Mailing Address - Fax:
Practice Address - Street 1:626 NW 4TH ST STE B
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6549
Practice Address - Country:US
Practice Address - Phone:541-758-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19138225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist