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General NPI Number Information
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NPI Number | 1144641192
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Entity Type | Individual
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Provider Name | JESSICA LAVOIE
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Gender | Female
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Dates
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Enumeration Date | 12/18/2013
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Last Update Date | 12/18/2013
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Provider Practice Location Address
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Address Line | 1 MEETING ST 3RD FLOOR, UNIT 2
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City | PROVIDENCE
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State | RI
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Zip | 02903-1214
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Country | US
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Telephone | 401-270-5077
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Fax |
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Provider Business Mailing Address
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Address Line | 15 HIGGINS ST UNIT 310
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City | SMITHFIELD
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State | RI
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Zip | 02917-4032
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Country | US
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Telephone | 401-640-7964
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT01347
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License Number State | RI
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