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General NPI Number Information
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NPI Number | 1063061828
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Entity Type | Individual
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Provider Name | MERYL ELIZABETH HAINES LMT
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Gender | Female
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Dates
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Enumeration Date | 09/04/2019
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 1320 SIMMS ST
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City | LAKEWOOD
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State | CO
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Zip | 80401-4478
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Country | US
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Telephone | 720-404-6467
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Fax |
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Provider Business Mailing Address
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Address Line | 6465 W 38TH AVE APT 103
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City | WHEAT RIDGE
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State | CO
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Zip | 80033-4971
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Country | US
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Telephone | 720-404-6467
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT.0019335
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License Number State | CO
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