Healthcare Provider Details

I. General information

NPI: 1174664239
Provider Name (Legal Business Name): MARJORIE LYNN VIGEANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 SPRINGHILL AVE
MARLBOROUGH MA
01752-2349
US

IV. Provider business mailing address

7 PRISCILLA DR
MARLBOROUGH MA
01752-2707
US

V. Phone/Fax

Practice location:
  • Phone: 508-624-8700
  • Fax:
Mailing address:
  • Phone: 508-485-2628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: