Provider Demographics
NPI:1881937860
Name:BISH, MAUREEN LOUISE (LMT)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:LOUISE
Last Name:BISH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2300 W ALAMEDA ST
Mailing Address - Street 2:CASITA A-5
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-9430
Mailing Address - Country:US
Mailing Address - Phone:505-471-9371
Mailing Address - Fax:
Practice Address - Street 1:1532 CERRILLOS RD
Practice Address - Street 2:SUITEC
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3512
Practice Address - Country:US
Practice Address - Phone:505-986-9109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist