Provider Demographics
NPI:1952167447
Name:PIKE, MARIAH MARLY (MMT)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:MARLY
Last Name:PIKE
Suffix:
Gender:F
Credentials:MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:AR
Mailing Address - Zip Code:72007-4002
Mailing Address - Country:US
Mailing Address - Phone:501-519-3495
Mailing Address - Fax:
Practice Address - Street 1:2120 W MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-7442
Practice Address - Country:US
Practice Address - Phone:501-519-3495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3791225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist