Provider Demographics
NPI:1578361150
Name:MCCANN-LILLIE, COLLEEN KATHRYN
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:KATHRYN
Last Name:MCCANN-LILLIE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 BUCK ST
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870-2035
Mailing Address - Country:US
Mailing Address - Phone:406-531-2509
Mailing Address - Fax:
Practice Address - Street 1:304 BUCK ST
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-2035
Practice Address - Country:US
Practice Address - Phone:406-531-2509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-24854225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist