Healthcare Provider Details

I. General information

NPI: 1609171321
Provider Name (Legal Business Name): YVONNE LAROSE CUPPETT CD(DONA)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YVONNE LAROSE CUPPETT L.M.T.

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 COLLIER RD
ACCIDENT MD
21520-1338
US

IV. Provider business mailing address

1241 COLLIER RD
ACCIDENT MD
21520-1338
US

V. Phone/Fax

Practice location:
  • Phone: 301-746-8055
  • Fax: 301-746-8055
Mailing address:
  • Phone: 301-746-8055
  • Fax: 301-746-8055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberROO146
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2004-1394
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: