Provider Demographics
NPI:1033561634
Name:TANNENBAUM, MARCY
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:TANNENBAUM
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 1:50 OLIVER ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1446
Mailing Address - Country:US
Mailing Address - Phone:508-230-9686
Mailing Address - Fax:
Practice Address - Street 1:50 OLIVER ST
Practice Address - Street 2:SUITE 204
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1446
Practice Address - Country:US
Practice Address - Phone:508-230-9686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1410225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist