Provider Demographics
NPI:1477805430
Name:FONSECA, KRISTIN LE LIEVRE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:LE LIEVRE
Last Name:FONSECA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:23 WATER ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-2364
Mailing Address - Country:US
Mailing Address - Phone:508-380-2581
Mailing Address - Fax:
Practice Address - Street 1:23 WATER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-2364
Practice Address - Country:US
Practice Address - Phone:508-380-2581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMT-524-MF225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist