Provider Demographics
NPI:1366615569
Name:PELLETIER, RACHEL (LMT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 734
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-0734
Mailing Address - Country:US
Mailing Address - Phone:207-967-0035
Mailing Address - Fax:614-489-0055
Practice Address - Street 1:2 CHRISTENSEN LN
Practice Address - Street 2:SUITE #3
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7759
Practice Address - Country:US
Practice Address - Phone:207-967-0035
Practice Address - Fax:614-489-0055
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT1982225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist