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General NPI Number Information
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NPI Number | 1912530148
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Entity Type | Individual
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Provider Name | SUSAN DIANE MACKEY LMT
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Gender | Female
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Dates
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Enumeration Date | 02/17/2020
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Last Update Date | 03/05/2020
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Provider Practice Location Address
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Address Line | 5810 SOUTHWYCK BLVD STE 100E
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City | TOLEDO
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State | OH
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Zip | 43614-1514
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Country | US
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Telephone | 419-340-2704
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2578
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City | WHITEHOUSE
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State | OH
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Zip | 43571-0578
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Country | US
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Telephone | 419-340-2704
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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 | 33.015285
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License Number State | OH
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