Provider Demographics
NPI:1891306189
Name:MCCORMICK, MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:MCCORMICK
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:S7045 SANDUSKY RD
Mailing Address - Street 2:
Mailing Address - City:HILLPOINT
Mailing Address - State:WI
Mailing Address - Zip Code:53937-9793
Mailing Address - Country:US
Mailing Address - Phone:608-415-9428
Mailing Address - Fax:
Practice Address - Street 1:348 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-1940
Practice Address - Country:US
Practice Address - Phone:608-415-9428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12638-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist