Healthcare Provider Details

I. General information

NPI: 1699553834
Provider Name (Legal Business Name): HEATHER LYNN MORSE MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER LYNN BESAW MASSAGE THERAPSIT

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 RIVER ST
WINDSOR VT
05089-1445
US

IV. Provider business mailing address

34 ASCUTNEY ST
WINDSOR VT
05089-1107
US

V. Phone/Fax

Practice location:
  • Phone: 802-291-3236
  • Fax:
Mailing address:
  • Phone: 802-230-6748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number164.0001433
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: