Provider Demographics
NPI:1477010718
Name:BOET-WHITAKER, CORINNE BARBARA (LMT)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:BARBARA
Last Name:BOET-WHITAKER
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 1:930 MAIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-5885
Mailing Address - Country:US
Mailing Address - Phone:978-929-9900
Mailing Address - Fax:
Practice Address - Street 1:930 MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-5885
Practice Address - Country:US
Practice Address - Phone:978-929-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15185225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist