Provider Demographics
NPI:1255668562
Name:LAVALLEE, ALICEANNE (NCBTMB)
Entity Type:Individual
Prefix:MRS
First Name:ALICEANNE
Middle Name:
Last Name:LAVALLEE
Suffix:
Gender:F
Credentials:NCBTMB
Other - Prefix:
Other - First Name:BUNNY
Other - Middle Name:
Other - Last Name:LAVALLEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NCBTMB
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:VT
Mailing Address - Zip Code:05778-0007
Mailing Address - Country:US
Mailing Address - Phone:802-989-9250
Mailing Address - Fax:
Practice Address - Street 1:422 SCHOOLHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:VT
Practice Address - Zip Code:05733
Practice Address - Country:US
Practice Address - Phone:802-989-9250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist