Individual
MRS. MARIE ANDERSON SELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS, MT, MI, CLT
Contact information
Practice address
4606 LADY JENNIFER DR, NACOGDOCHES, TX 75965-0988
(936) 564-1900
(866) 643-7117
Mailing address
4606 LADY JENNIFER DR, NACOGDOCHES, TX 75965-0988
(936) 564-1900
(866) 643-7117
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
14840 CLT
TX
225700000X
Massage Therapist
MI01932
TX
225700000X
Massage Therapist
Primary
MT011782
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14840
CLT-NLN MEMBER
TX
01
—
MI01932
LMT INSTRUCTOR
TX
01
—
MT011782
LICENSED MASSAGE THERAPIS
TX
Enumeration date
11/16/2006
Last updated
07/08/2007
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