Healthcare Provider Details

I. General information

NPI: 1952121113
Provider Name (Legal Business Name): KARLA ARCHAMBEAULT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ALBANY RD STE 7
WEST STOCKBRIDGE MA
01266-9508
US

IV. Provider business mailing address

35 MIDDLE RD
AUSTERLITZ NY
12017-1718
US

V. Phone/Fax

Practice location:
  • Phone: 860-638-8136
  • Fax:
Mailing address:
  • Phone: 860-638-8136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12128
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: