Provider Demographics
NPI:1275908410
Name:RAYMOND, MARLAINE
Entity Type:Individual
Prefix:MS
First Name:MARLAINE
Middle Name:
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARLAINE
Other - Middle Name:
Other - Last Name:RAYMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT
Mailing Address - Street 1:2860 HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-1867
Mailing Address - Country:US
Mailing Address - Phone:850-702-1793
Mailing Address - Fax:
Practice Address - Street 1:4154 LAFAYETTE ST
Practice Address - Street 2:STE E
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-8282
Practice Address - Country:US
Practice Address - Phone:850-702-1793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-13
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA54190173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist