Provider Demographics
NPI:1073654216
Name:VAUTIER, LORI REBA (CMTHE, MFT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:REBA
Last Name:VAUTIER
Suffix:
Gender:F
Credentials:CMTHE, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 YOSEMITE AVE
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638
Mailing Address - Country:US
Mailing Address - Phone:559-706-0341
Mailing Address - Fax:
Practice Address - Street 1:219 YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638
Practice Address - Country:US
Practice Address - Phone:559-706-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist