Provider Demographics
NPI:1124310297
Name:MCCANN, AUBRIANNA RACHELLE
Entity type:Individual
Prefix:
First Name:AUBRIANNA
Middle Name:RACHELLE
Last Name:MCCANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-4502
Mailing Address - Country:US
Mailing Address - Phone:360-470-8551
Mailing Address - Fax:
Practice Address - Street 1:324 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-4502
Practice Address - Country:US
Practice Address - Phone:360-470-8551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2021-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60205541225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist