Individual
MARY ANN MCMICHAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CHP, LMT
Contact information
Practice address
12305 GOLD ST STE 9, OMAHA, NE 68144-2760
(402) 672-8738
Mailing address
12305 GOLD ST STE 9, OMAHA, NE 68144-2760
(402) 672-8738
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
3759
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3029
LMT ESTABLISHMENT LICENSE
NE
01
—
3759
LMT LICENSE
NE
Enumeration date
07/24/2020
Last updated
07/24/2020
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