Provider Demographics
NPI:1386899151
Name:DOUCETTE, KAREN VICTORIA (LMT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:VICTORIA
Last Name:DOUCETTE
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 1:489 WESTFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-2132
Mailing Address - Country:US
Mailing Address - Phone:585-402-6614
Mailing Address - Fax:585-529-3516
Practice Address - Street 1:1687 ENGLISH RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-1609
Practice Address - Country:US
Practice Address - Phone:585-292-6428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021892225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist