Healthcare Provider Details

I. General information

NPI: 1750891669
Provider Name (Legal Business Name): JULANNE MARIE TUTTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CANAL ST STE 2
SALEM MA
01970-4649
US

IV. Provider business mailing address

111 CANAL ST STE A
SALEM MA
01970-4649
US

V. Phone/Fax

Practice location:
  • Phone: 978-744-1123
  • Fax: 978-594-4605
Mailing address:
  • Phone: 617-257-2352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6447
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: