Provider Demographics
NPI:1750348728
Name:LEPAGE, CATHERINE MARY FRANCES (OTR/L, CHT)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:MARY FRANCES
Last Name:LEPAGE
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:M
Other - Last Name:MARCILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, CHT
Mailing Address - Street 1:150 MIDWAY ROAD
Mailing Address - Street 2:SUITE 173
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-5745
Mailing Address - Country:US
Mailing Address - Phone:401-942-3343
Mailing Address - Fax:401-942-3733
Practice Address - Street 1:150 MIDWAY RD
Practice Address - Street 2:SUITE 173
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5710
Practice Address - Country:US
Practice Address - Phone:401-942-3343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT00813174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007009519Medicare ID - Type Unspecified