Provider Demographics
NPI:1639773310
Name:GAUTHIER, JOANNE HELEN
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:HELEN
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MEETING HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-1732
Mailing Address - Country:US
Mailing Address - Phone:860-333-2669
Mailing Address - Fax:
Practice Address - Street 1:150 MEETING HOUSE LN
Practice Address - Street 2:
Practice Address - City:LEDYARD
Practice Address - State:CT
Practice Address - Zip Code:06339-1732
Practice Address - Country:US
Practice Address - Phone:860-333-2669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003962225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty