Healthcare Provider Details

I. General information

NPI: 1366351512
Provider Name (Legal Business Name): MARIAH S MCHALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 E MAIN ST STE 105106
CLAYTON NC
27520-2528
US

IV. Provider business mailing address

495 WESTERMAN PL
SMITHFIELD NC
27577-6923
US

V. Phone/Fax

Practice location:
  • Phone: 714-319-5158
  • Fax:
Mailing address:
  • Phone: 714-319-5158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22717
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: