Healthcare Provider Details

I. General information

NPI: 1073825576
Provider Name (Legal Business Name): GRETCHEN W WETHERBY BA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 BRIDGE ST
MILLERS FALLS MA
01349-1336
US

IV. Provider business mailing address

14 BRIDGE ST
MILLERS FALLS MA
01349-1336
US

V. Phone/Fax

Practice location:
  • Phone: 413-824-7063
  • Fax:
Mailing address:
  • Phone: 413-824-7063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number557
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: