Provider Demographics
NPI:1881835825
Name:EGGINK, MAIKE E (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MAIKE
Middle Name:E
Last Name:EGGINK
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 1:96 WOODSHIRE N
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1580
Mailing Address - Country:US
Mailing Address - Phone:716-830-7372
Mailing Address - Fax:716-810-2159
Practice Address - Street 1:96 WOODSHIRE N
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1580
Practice Address - Country:US
Practice Address - Phone:716-830-7372
Practice Address - Fax:716-810-2159
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-22
Last Update Date:2009-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016893-2225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist