Provider Demographics
NPI:1003463340
Name:MENTELE, MARCIA MAE
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:MAE
Last Name:MENTELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4627 W HOMEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-3511
Mailing Address - Country:US
Mailing Address - Phone:605-336-2010
Mailing Address - Fax:605-336-0249
Practice Address - Street 1:4627 W HOMEFIELD DR
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3511
Practice Address - Country:US
Practice Address - Phone:605-336-2010
Practice Address - Fax:605-336-0249
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty