Provider Demographics
NPI:1568870707
Name:REVETTE, MARIE ADELE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ADELE
Last Name:REVETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REDEL
Other - Middle Name:
Other - Last Name:REVETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2-2488 KAUMUALII HWY
Mailing Address - Street 2:BLDG. #2
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-8311
Mailing Address - Country:US
Mailing Address - Phone:808-335-5808
Mailing Address - Fax:808-335-5657
Practice Address - Street 1:126 PHOENIX AVE
Practice Address - Street 2:BLDG. #2
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-4931
Practice Address - Country:US
Practice Address - Phone:978-453-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist