Healthcare Provider Details

I. General information

NPI: 1740823699
Provider Name (Legal Business Name): JOYCE HAUBER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LAGRANGE RD
HOWLAND ME
04448-3743
US

IV. Provider business mailing address

PO BOX 454
HOWLAND ME
04448-0454
US

V. Phone/Fax

Practice location:
  • Phone: 207-732-7165
  • Fax:
Mailing address:
  • Phone: 207-732-7165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT5686
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: