Provider Demographics
NPI:1922545573
Name:HORTON, MARIA (MT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17001 COUNTY ROAD CD
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-9380
Mailing Address - Country:US
Mailing Address - Phone:906-869-2760
Mailing Address - Fax:
Practice Address - Street 1:17001 COUNTY ROAD CD
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-9380
Practice Address - Country:US
Practice Address - Phone:906-869-2760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501006482225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist