Healthcare Provider Details

I. General information

NPI: 1942123831
Provider Name (Legal Business Name): ISYSS RAE REMILLARD LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 ELM ST
GORHAM ME
04038-1506
US

IV. Provider business mailing address

12 ELM ST
GORHAM ME
04038-1506
US

V. Phone/Fax

Practice location:
  • Phone: 207-600-9287
  • Fax:
Mailing address:
  • Phone: 207-600-9287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT8276
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: