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General NPI Number Information
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NPI Number | 1265704373
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Entity Type | Individual
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Provider Name | BECKY A ELLSWORTH A.A.S, LCMT
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Gender | Female
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Dates
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Enumeration Date | 02/04/2012
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Last Update Date | 02/04/2012
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Provider Practice Location Address
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Address Line | 7 GEORGE ST
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City | PAWTUCKET
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State | RI
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Zip | 02860-4006
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Country | US
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Telephone | 401-206-1438
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Fax |
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Provider Business Mailing Address
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Address Line | 77 LEVESQUE ST
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City | WARWICK
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State | RI
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Zip | 02886-0752
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Country | US
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Telephone | 401-206-1438
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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 | MT01068
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License Number State | RI
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