Provider Demographics
NPI:1497134878
Name:HANCOCK, MARYANN (LMT)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:HANCOCK
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 1:812 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-5526
Mailing Address - Country:US
Mailing Address - Phone:517-230-8193
Mailing Address - Fax:
Practice Address - Street 1:1770 E GRAND RIVER AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4907
Practice Address - Country:US
Practice Address - Phone:517-230-8193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL220690225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist