Healthcare Provider Details

I. General information

NPI: 1376068072
Provider Name (Legal Business Name): MARCY KATHERINE YAUCHLER MTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 08/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35080 US HIGHWAY 19 N
PALM HARBOR FL
34684-1925
US

IV. Provider business mailing address

1740 ROSERY RD NE
LARGO FL
33771-1682
US

V. Phone/Fax

Practice location:
  • Phone: 727-789-5711
  • Fax:
Mailing address:
  • Phone: 727-638-0994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZA2600X
TaxonomyMedical Art Specialist/Technologist
License Number52441455941
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: