Provider Demographics
NPI:1184218851
Name:MCCAUL, EMILY (LMT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MCCAUL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:719 FRONT ST UNIT 107
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-5278
Mailing Address - Country:US
Mailing Address - Phone:401-769-4263
Mailing Address - Fax:
Practice Address - Street 1:719 FRONT ST UNIT 107
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-5278
Practice Address - Country:US
Practice Address - Phone:401-769-4263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMT01944225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist