Provider Demographics
NPI:1326319815
Name:VAUGHN, RENEE LEIGH (LMT, NCTMB)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:LEIGH
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4917
Mailing Address - Country:US
Mailing Address - Phone:845-532-8630
Mailing Address - Fax:
Practice Address - Street 1:101 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4917
Practice Address - Country:US
Practice Address - Phone:845-532-8630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019207225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist