Provider Demographics
NPI:1962998872
Name:KRAELING, MARIAN (LMT)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:KRAELING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4434
Mailing Address - Country:US
Mailing Address - Phone:516-417-6715
Mailing Address - Fax:
Practice Address - Street 1:1028 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4434
Practice Address - Country:US
Practice Address - Phone:516-417-6715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010196-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist