Provider Demographics
NPI:1467753996
Name:ROBERTS, MARCY RAE (BS)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:RAE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7101
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59904-0101
Mailing Address - Country:US
Mailing Address - Phone:406-253-4133
Mailing Address - Fax:406-752-3130
Practice Address - Street 1:886 LONE COYOTE TRL
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-0801
Practice Address - Country:US
Practice Address - Phone:406-253-4133
Practice Address - Fax:406-752-3133
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator