Provider Demographics
NPI:1487863932
Name:INGRAHAM, MARIANN (ATC,LAT)
Entity Type:Individual
Prefix:MRS
First Name:MARIANN
Middle Name:
Last Name:INGRAHAM
Suffix:
Gender:F
Credentials:ATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 EASTON ST
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MA
Mailing Address - Zip Code:01033-9518
Mailing Address - Country:US
Mailing Address - Phone:413-467-3532
Mailing Address - Fax:
Practice Address - Street 1:291 SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-2837
Practice Address - Country:US
Practice Address - Phone:413-265-2318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer