Susan McClellan, MASG-897
Individual provider Active NPI Massage Therapist · Spirit Lake, ID
NPI 1083003263 · NPPES record last updated Jan 12, 2015
Key facts
- NPI
- 1083003263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- MASG-897 (ID)
- Practice address
- 5868 W. Massachusetts St
Spirit Lake, ID 83869-1173 - Phone
- (208) 651-1591
- NPI assigned
- Jan 12, 2015
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MASG-897 | ID | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MASG-897 | ID | Yes |
Addresses
Primary practice location
5868 W. Massachusetts St
Spirit Lake, ID 83869-1173
Mailing address
PO Box 1173
5868 W. Massachusetts St
Spirit Lake, ID 83869-1173
Phone (208) 651-1591
Other providers in Spirit Lake, ID
- Deblaquiere Enterprises Inc
- Terry Tobias Devore
- Betty M Franzatti
- Jacquelyn Rose Mallet
- Daniel Michael Marrocco
- Mountain Country Family Healthcare, PLLC
- Mountain Springs Assisted Living Center LLC
- Michael Victor Nowack
- Ann Oehlert
- Loree Peery
All providers in Spirit Lake, ID · Massage Therapist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 12, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.