Healthcare Provider Details

I. General information

NPI: 1134051832
Provider Name (Legal Business Name): DANIELLE BEAUDOIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 QUAKER LN STE 201
WEST WARWICK RI
02893-2179
US

IV. Provider business mailing address

120 LYMAN AVE
WARWICK RI
02888-2217
US

V. Phone/Fax

Practice location:
  • Phone: 401-714-7363
  • Fax:
Mailing address:
  • Phone: 401-714-7363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-01603
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: