MEDICARE: MARIANNE ROBINSON MACDONALD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	0683	CT

General Provider Information

NPI Number	:	1336742394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANNE ROBINSON MACDONALD

Provider Business Mailing Address
First Line	:	129 DOROTHY DR
Second Line	:
City	:	TORRINGTON
State	:	CT
Zip	:	06790-4212
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 FISHER DR
Second Line	:
City	:	AVON
State	:	CT
Zip	:	06001-3798
Country	:	US
Telephone Number	:	860-696-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	02/10/2021

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