Individual
MARISA CHADBOURNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
124 MAIN STREET, SAYVILLE, NY 11782-2952
(631) 403-6013
Mailing address
PO BOX 53, SAYVILLE, NY 11782-0053
(631) 403-6013
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
021161
NY
Other
Enumeration date
12/03/2014
Last updated
06/29/2023
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