Provider Demographics
NPI:1528463114
Name:GAUDETTE, RUBIE (ATC)
Entity type:Individual
Prefix:
First Name:RUBIE
Middle Name:
Last Name:GAUDETTE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1714
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-1714
Mailing Address - Country:US
Mailing Address - Phone:207-281-2082
Mailing Address - Fax:
Practice Address - Street 1:164 OLD ALFRED RD
Practice Address - Street 2:
Practice Address - City:ARUNDEL
Practice Address - State:ME
Practice Address - Zip Code:04046-8743
Practice Address - Country:US
Practice Address - Phone:207-281-2082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-26
Last Update Date:2014-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer