Healthcare Provider Details

I. General information

NPI: 1659475820
Provider Name (Legal Business Name): MS. ANDREE GODMAIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 ETNA ROAD BUILDING 1 SUITE 1
LEBANON NH
03766
US

IV. Provider business mailing address

260 METHODIST HILL RD
PLAINFIELD NH
03781-5418
US

V. Phone/Fax

Practice location:
  • Phone: 603-448-4251
  • Fax: 603-448-4251
Mailing address:
  • Phone: 603-448-1059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberC20104 (BOC)
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: