Individual
MRS. MARY ELLEN PICCOLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, LMP
Contact information
Practice address
1121 WALLINGFORD CT NE, LACEY, WA 98516-5836
(971) 533-6816
Mailing address
1121 WALLINGFORD CT NE, LACEY, WA 98516-5836
(971) 533-6816
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
MA60079242
WA
Other
Enumeration date
09/29/2009
Last updated
09/29/2009
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