Provider Demographics
NPI:1114793502
Name:MOULTON, TABATHA (LMT)
Entity Type:Individual
Prefix:
First Name:TABATHA
Middle Name:
Last Name:MOULTON
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 1:13 MARCH FARM WAY
Mailing Address - Street 2:
Mailing Address - City:GREENLAND
Mailing Address - State:NH
Mailing Address - Zip Code:03840-6234
Mailing Address - Country:US
Mailing Address - Phone:603-702-5584
Mailing Address - Fax:
Practice Address - Street 1:13 MARCH FARM WAY
Practice Address - Street 2:
Practice Address - City:GREENLAND
Practice Address - State:NH
Practice Address - Zip Code:03840-6234
Practice Address - Country:US
Practice Address - Phone:603-702-5584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist