Provider Demographics
NPI:1275997520
Name:MARINER, KRISTINA (LMT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:MARINER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04087-3100
Mailing Address - Country:US
Mailing Address - Phone:207-749-7922
Mailing Address - Fax:
Practice Address - Street 1:935 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBORO
Practice Address - State:ME
Practice Address - Zip Code:04087
Practice Address - Country:US
Practice Address - Phone:207-749-7922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT4178225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist