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General NPI Number Information
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NPI Number | 1497134878
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Entity Type | Individual
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Provider Name | MARYANN HANCOCK L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 05/19/2015
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 1770 E GRAND RIVER AVE SUITE 300
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City | EAST LANSING
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State | MI
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Zip | 48823-4907
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Country | US
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Telephone | 517-230-8193
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Fax |
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Provider Business Mailing Address
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Address Line | 812 CLARK ST
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City | LANSING
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State | MI
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Zip | 48906-5526
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Country | US
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Telephone | 517-230-8193
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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 | L220690
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License Number State | MI
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