Provider Demographics
NPI:1093416877
Name:GAUTHIER, TANGELA MARIE
Entity Type:Individual
Prefix:
First Name:TANGELA
Middle Name:MARIE
Last Name:GAUTHIER
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 1:483 OTIS RD
Mailing Address - Street 2:
Mailing Address - City:BECKET
Mailing Address - State:MA
Mailing Address - Zip Code:01223-5714
Mailing Address - Country:US
Mailing Address - Phone:413-212-1113
Mailing Address - Fax:
Practice Address - Street 1:483 OTIS RD
Practice Address - Street 2:
Practice Address - City:BECKET
Practice Address - State:MA
Practice Address - Zip Code:01223-5714
Practice Address - Country:US
Practice Address - Phone:413-212-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician