Provider Demographics
NPI:1396122313
Name:MARIK, BETH (LMT, BCTMB)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:MARIK
Suffix:
Gender:F
Credentials:LMT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 S CENTRAL ST
Mailing Address - Street 2:#1
Mailing Address - City:BRADFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01835-7546
Mailing Address - Country:US
Mailing Address - Phone:708-261-7474
Mailing Address - Fax:
Practice Address - Street 1:58 S CENTRAL ST
Practice Address - Street 2:#1
Practice Address - City:BRADFORD
Practice Address - State:MA
Practice Address - Zip Code:01835-7546
Practice Address - Country:US
Practice Address - Phone:708-261-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMT-12626-MT225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist