Provider Demographics
NPI:1952670325
Name:GAUDREAULT, KATHERINE (NCMT)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
Last Name:GAUDREAULT
Suffix:
Gender:F
Credentials:NCMT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:GAUDREAULT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NCMT
Mailing Address - Street 1:PO BOX 3665
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186
Mailing Address - Country:UM
Mailing Address - Phone:540-222-0669
Mailing Address - Fax:
Practice Address - Street 1:92 MAIN ST
Practice Address - Street 2:SUITE 202-4
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3366
Practice Address - Country:US
Practice Address - Phone:540-222-0669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019008401225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist