Provider Demographics
NPI:1073825576
Name:WETHERBY, GRETCHEN W (BA LMT)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:W
Last Name:WETHERBY
Suffix:
Gender:F
Credentials:BA LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MILLERS FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01349-1336
Mailing Address - Country:US
Mailing Address - Phone:413-824-7063
Mailing Address - Fax:
Practice Address - Street 1:14 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:MILLERS FALLS
Practice Address - State:MA
Practice Address - Zip Code:01349-1336
Practice Address - Country:US
Practice Address - Phone:413-824-7063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA557225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist