Marisa Chadbourne, LMT
Massage Therapist in Sayville, NY. Individual provider (NPI-1).
NPI number1003213232
StatusActive
Last updated in NPPESJun 29, 2023
Details
- NPI
- 1003213232
- Entity type
- Individual (NPI-1)
- Name
- Marisa Chadbourne
- Credential
- LMT
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Dec 3, 2014
- Certification date
- Jun 15, 2023
- Last updated
- Jun 29, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225700000X | Massage Therapist | 021161 | NY | Yes |
Practice location
124 Main StreetSayville, NY 11782-2952
Phone 631-403-6013
Mailing address
Po Box 53Sayville, NY 11782-0053
Phone 631-403-6013
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