Provider Demographics
NPI:1487800843
Name:EAKLE, MARCIE MARIE (LMT)
Entity type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:MARIE
Last Name:EAKLE
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 1:34 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:LOST CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26385-9645
Mailing Address - Country:US
Mailing Address - Phone:304-629-8484
Mailing Address - Fax:
Practice Address - Street 1:410 WATER ST
Practice Address - Street 2:
Practice Address - City:STONEWOOD
Practice Address - State:WV
Practice Address - Zip Code:26301-4649
Practice Address - Country:US
Practice Address - Phone:304-629-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20082382172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker