Provider Demographics
NPI:1093271256
Name:STASIO-REPPUCCI, LINDA MAUREEN
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MAUREEN
Last Name:STASIO-REPPUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03841-2300
Mailing Address - Country:US
Mailing Address - Phone:781-248-4716
Mailing Address - Fax:
Practice Address - Street 1:1 BRANCH ST STE 202
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-1923
Practice Address - Country:US
Practice Address - Phone:978-973-0643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7524225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty