Provider Demographics
NPI:1912992686
Name:LAMARRE, WAYNE RICHARD (MED, ATC, LAT)
Entity Type:Individual
Prefix:PROF
First Name:WAYNE
Middle Name:RICHARD
Last Name:LAMARRE
Suffix:
Gender:M
Credentials:MED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HALE RD
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04071-6101
Mailing Address - Country:US
Mailing Address - Phone:207-602-2412
Mailing Address - Fax:
Practice Address - Street 1:11 HILLS BEACH RD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9526
Practice Address - Country:US
Practice Address - Phone:207-602-2412
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT193174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist