Healthcare Provider Details

I. General information

NPI: 1891305777
Provider Name (Legal Business Name): PAULETTE GUILBAULT LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 E YELM AVE STE C101
YELM WA
98597-8328
US

IV. Provider business mailing address

1412 E YELM AVE STE C101
YELM WA
98597-8328
US

V. Phone/Fax

Practice location:
  • Phone: 306-458-7533
  • Fax: 360-458-7699
Mailing address:
  • Phone: 306-458-7533
  • Fax: 360-458-7699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60886389
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: