Provider Demographics
NPI:1477890085
Name:RICHARD, EMILY MAY (LMT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MAY
Last Name:RICHARD
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 1:17B PIERCE AVE
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-7111
Mailing Address - Country:US
Mailing Address - Phone:978-345-1224
Mailing Address - Fax:978-345-1418
Practice Address - Street 1:17B PIERCE AVE
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-7111
Practice Address - Country:US
Practice Address - Phone:978-345-1224
Practice Address - Fax:978-345-1418
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10729225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist