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General NPI Number Information
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NPI Number | 1942532379
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Entity Type | Individual
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Provider Name | ALICIA FAVREAU
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Gender | Female
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Dates
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Enumeration Date | 02/10/2010
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 1123 SOUTH ST
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City | FITCHBURG
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State | MA
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Zip | 01420-7057
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Country | US
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Telephone | 978-877-6978
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Fax |
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Provider Business Mailing Address
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Address Line | 23 STATE ST APT K
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City | LEOMINSTER
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State | MA
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Zip | 01453-1512
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Country | US
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Telephone | 978-877-6978
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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 | 6225
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License Number State | MA
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