Healthcare Provider Details

I. General information

NPI: 1417230459
Provider Name (Legal Business Name): LISA MARIE MARIACHER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4269 SAINT FRANCIS DR
HAMBURG NY
14075-1724
US

IV. Provider business mailing address

34 QUEENS DR
WEST SENECA NY
14224-3227
US

V. Phone/Fax

Practice location:
  • Phone: 716-627-3668
  • Fax:
Mailing address:
  • Phone: 716-544-4436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number016714
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: