Provider Demographics
NPI:1598458176
Name:YOCUM, MAREIKE A
Entity Type:Individual
Prefix:
First Name:MAREIKE
Middle Name:A
Last Name:YOCUM
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 1:6912 HOLLY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-3025
Mailing Address - Country:US
Mailing Address - Phone:502-744-5240
Mailing Address - Fax:
Practice Address - Street 1:201 MOSER RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3173
Practice Address - Country:US
Practice Address - Phone:502-653-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252772225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist