Provider Demographics
NPI:1942373162
Name:SELL, MARIE ANDERSON (BS, MT, MI, CLT)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ANDERSON
Last Name:SELL
Suffix:
Gender:F
Credentials:BS, MT, MI, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 LADY JENNIFER DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-0988
Mailing Address - Country:US
Mailing Address - Phone:936-564-1900
Mailing Address - Fax:866-643-7117
Practice Address - Street 1:4606 LADY JENNIFER DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-0988
Practice Address - Country:US
Practice Address - Phone:936-564-1900
Practice Address - Fax:866-643-7117
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT011782225700000X
TXMI01932225700000X
TX14840 CLT225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMI01932OtherLMT INSTRUCTOR
TX14840OtherCLT-NLN MEMBER
TXMT011782OtherLICENSED MASSAGE THERAPIS