Provider Demographics
NPI:1134418643
Name:BAYETIS, NICOLE JOYCE
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:JOYCE
Last Name:BAYETIS
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 1:224 GARBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-9815
Mailing Address - Country:US
Mailing Address - Phone:802-442-8820
Mailing Address - Fax:
Practice Address - Street 1:532 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2875
Practice Address - Country:US
Practice Address - Phone:802-447-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist