Provider Demographics
NPI:1578627493
Name:THIBODEAU, CELIA R (L AC M AC DIPL ADS C)
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:R
Last Name:THIBODEAU
Suffix:
Gender:F
Credentials:L AC M AC DIPL ADS C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGVALE
Mailing Address - State:ME
Mailing Address - Zip Code:04083
Mailing Address - Country:US
Mailing Address - Phone:207-490-4190
Mailing Address - Fax:
Practice Address - Street 1:554 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083
Practice Address - Country:US
Practice Address - Phone:207-490-4190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC161171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist