Provider Demographics
NPI:1043712169
Name:RAYMOND, SIOBHAN MARIE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:MARIE
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 ROOSEVELT TRL UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5652
Mailing Address - Country:US
Mailing Address - Phone:207-892-8356
Mailing Address - Fax:207-892-1644
Practice Address - Street 1:936 ROOSEVELT TRL UNIT 2
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5652
Practice Address - Country:US
Practice Address - Phone:207-892-8356
Practice Address - Fax:207-892-1644
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT4971225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist