=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538949979
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA LOUISE LANCEY LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2023
-----------------------------------------------------
Last Update Date | 10/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 277 MOUNT MAJOR HWY UNIT 1
-----------------------------------------------------
City | ALTON BAY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03810-4454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-616-1783
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 277 MOUNT MAJOR HWY UNIT 1
-----------------------------------------------------
City | ALTON BAY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03810-4454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-616-1783
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 3993
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------