Provider Demographics
NPI:1194048637
Name:SAUTTE, RENEE (MA 60112860)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:SAUTTE
Suffix:
Gender:F
Credentials:MA 60112860
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9528 STATE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-2279
Mailing Address - Country:US
Mailing Address - Phone:360-659-6554
Mailing Address - Fax:
Practice Address - Street 1:9528 STATE AVE STE B
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270
Practice Address - Country:US
Practice Address - Phone:360-659-6554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60112860225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist