Provider Demographics
NPI:1932651825
Name:SKRUTSKI, HEATHER MARY (LMT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARY
Last Name:SKRUTSKI
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 1:97 TOOTLE LN
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5005
Mailing Address - Country:US
Mailing Address - Phone:508-264-6809
Mailing Address - Fax:
Practice Address - Street 1:97 TOOTLE LN
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-5005
Practice Address - Country:US
Practice Address - Phone:508-264-6809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13720225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist