Provider Demographics
NPI:1861966962
Name:MARQUIS, MICHELLE EARLE (LMT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:EARLE
Last Name:MARQUIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MIXHI
Other - Middle Name:EARLE
Other - Last Name:MARQUIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:330 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-9365
Mailing Address - Country:US
Mailing Address - Phone:574-537-2680
Mailing Address - Fax:574-533-0218
Practice Address - Street 1:330 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-9365
Practice Address - Country:US
Practice Address - Phone:574-537-2680
Practice Address - Fax:574-533-0218
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT21405285225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist