Provider Demographics
NPI:1134241821
Name:AYOTTE, MARK LOUIS (ATC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:LOUIS
Last Name:AYOTTE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 TAIT RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3844
Mailing Address - Country:US
Mailing Address - Phone:203-254-4000
Mailing Address - Fax:
Practice Address - Street 1:FAIRFIELD UNIVERSITY 1073 NORTH BENSON ROAD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5171
Practice Address - Country:US
Practice Address - Phone:203-395-6482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0001132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer