Provider Demographics
NPI:1215145586
Name:CHAMPOUX, RHIANA LEE (COTAL)
Entity type:Individual
Prefix:
First Name:RHIANA
Middle Name:LEE
Last Name:CHAMPOUX
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PETERS STREET SUITE 1
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-3201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 PETERS STREET SUITE 1
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-3201
Practice Address - Country:US
Practice Address - Phone:978-237-5106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2286973163W00000X
MA2850247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other