MEDICARE: MARIBAH FOX

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	197110	AK

General Provider Information

NPI Number	:	1356060388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIBAH FOX

Provider Business Mailing Address
First Line	:	1045 E KLATT RD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-3665
Country	:	US
Telephone Number	:	907-331-6228
Fax Number	:

Provider Business Practice Location Address
First Line	:	1045 E KLATT RD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-3665
Country	:	US
Telephone Number	:	907-331-6228
Fax Number	:

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

Provider Enumeration Date	:	08/23/2022
Last Update Date	:	08/23/2022

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Directions to “ MARIBAH FOX ” Practice Location

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