Provider Demographics
NPI:1447842331
Name:CHIASSON, PAMELA GAE (LMT)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:GAE
Last Name:CHIASSON
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 1:43 BROAD ST STE B310
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-2568
Mailing Address - Country:US
Mailing Address - Phone:978-852-0270
Mailing Address - Fax:
Practice Address - Street 1:43 BROAD ST STE B310
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-2568
Practice Address - Country:US
Practice Address - Phone:978-852-0270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13722225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist