Provider Demographics
NPI:1033678677
Name:TROTTER, MARY JANE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:TROTTER
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7360 GRACE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2470
Mailing Address - Country:US
Mailing Address - Phone:410-660-6062
Mailing Address - Fax:
Practice Address - Street 1:7360 GRACE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2470
Practice Address - Country:US
Practice Address - Phone:410-660-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM05241225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist