Provider Demographics
NPI:1346721123
Name:WORD, MARCY ( TANYA ) MARCELLE
Entity Type:Individual
Prefix:
First Name:MARCY ( TANYA )
Middle Name:MARCELLE
Last Name:WORD
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 1:1885 COUNTY ROAD 187D
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-1205
Mailing Address - Country:US
Mailing Address - Phone:903-808-1876
Mailing Address - Fax:
Practice Address - Street 1:1885 COUNTY ROAD 187D
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-1205
Practice Address - Country:US
Practice Address - Phone:903-808-1876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2035731225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant