Provider Demographics
NPI:1790123750
Name:THIBODEAU, LOIS W (LMBT)
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:W
Last Name:THIBODEAU
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 7 OAKS DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-7319
Mailing Address - Country:US
Mailing Address - Phone:910-297-0011
Mailing Address - Fax:
Practice Address - Street 1:804 7 OAKS DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-7319
Practice Address - Country:US
Practice Address - Phone:910-297-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1727225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist