Provider Demographics
NPI:1558038042
Name:WILLETTE, KRISTY MARIE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:KRISTY
Middle Name:MARIE
Last Name:WILLETTE
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 1:374 SOUTH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9397
Mailing Address - Country:US
Mailing Address - Phone:207-219-0462
Mailing Address - Fax:
Practice Address - Street 1:311 ALFRED ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3127
Practice Address - Country:US
Practice Address - Phone:207-286-8416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT6859225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMT6859OtherLMT