Healthcare Provider Details

I. General information

NPI: 1235586488
Provider Name (Legal Business Name): MAGGIE HEJL BA, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W CEDAR AVE
PALMER AK
99645-6309
US

IV. Provider business mailing address

8380 E GOLD BULLION BLVD
PALMER AK
99645
US

V. Phone/Fax

Practice location:
  • Phone: 907-795-6545
  • Fax:
Mailing address:
  • Phone: 907-795-6545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number101465
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: