Provider Demographics
NPI:1245433309
Name:REID WILLIAM SALON & DAY SPA
Entity type:Organization
Organization Name:REID WILLIAM SALON & DAY SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THERIAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-772-1772
Mailing Address - Street 1:509 FOREST AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-1521
Mailing Address - Country:US
Mailing Address - Phone:207-772-1772
Mailing Address - Fax:207-772-1744
Practice Address - Street 1:509 FOREST AVE STE 4
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1521
Practice Address - Country:US
Practice Address - Phone:207-772-1772
Practice Address - Fax:207-772-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEES35682225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty