Individual
TAMMY MARIE MAC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
850 W IRONWOOD DR STE 302, COEUR D ALENE, ID 83814-4903
(208) 664-5225
Mailing address
850 W IRONWOOD DR # DR302, COEUR D ALENE, ID 83814-4903
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-2984
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MAS-2984
MASSAGE THERAPIST LICENSE
ID
Enumeration date
07/07/2017
Last updated
07/07/2017
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