Provider Demographics
NPI:1174664239
Name:VIGEANT, MARJORIE LYNN
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:LYNN
Last Name:VIGEANT
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 1:7 PRISCILLA DR
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-2707
Mailing Address - Country:US
Mailing Address - Phone:508-485-2628
Mailing Address - Fax:
Practice Address - Street 1:31 SPRINGHILL AVE
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-2349
Practice Address - Country:US
Practice Address - Phone:508-624-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist