Provider Demographics
NPI:1083003206
Name:FOUCH, MARYANN
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:
Last Name:FOUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARYANN
Other - Middle Name:
Other - Last Name:GAUTHIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMT
Mailing Address - Street 1:545 S. GARFIELD AVE.
Mailing Address - Street 2:SUITE C
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686
Mailing Address - Country:US
Mailing Address - Phone:231-947-7550
Mailing Address - Fax:
Practice Address - Street 1:545 S. GARFIELD AVE.
Practice Address - Street 2:SUITE C
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686
Practice Address - Country:US
Practice Address - Phone:231-947-7550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist