Provider Demographics
NPI:1073275962
Name:BEAUDOIN, SUSANNE MARIE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:MARIE
Last Name:BEAUDOIN
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 1:8 JACKSON CT
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-2715
Mailing Address - Country:US
Mailing Address - Phone:508-654-8809
Mailing Address - Fax:
Practice Address - Street 1:8 JACKSON CT
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-2715
Practice Address - Country:US
Practice Address - Phone:508-654-8809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1619225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist