Provider Demographics
NPI:1568172906
Name:FREDETTE, TAMMIE MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:MARIE
Last Name:FREDETTE
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 1:498 STICKNEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:NH
Mailing Address - Zip Code:03229-2005
Mailing Address - Country:US
Mailing Address - Phone:603-219-2185
Mailing Address - Fax:
Practice Address - Street 1:498 STICKNEY HILL RD
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:NH
Practice Address - Zip Code:03229-2005
Practice Address - Country:US
Practice Address - Phone:603-219-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8317225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist