Provider Demographics
NPI:1942410162
Name:MCCAIN, MARY L
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:L
Last Name:MCCAIN
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 1:2931 W SKOKOMISH VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-6455
Mailing Address - Country:US
Mailing Address - Phone:360-426-2985
Mailing Address - Fax:
Practice Address - Street 1:2931 W SKOKOMISH VALLEY RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-6455
Practice Address - Country:US
Practice Address - Phone:360-426-2985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00003340174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist