MEDICARE: JENNIFER LYNN SPERBER-GARRISON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	7501002517	MI

General Provider Information

NPI Number	:	1306557988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNN SPERBER-GARRISON

Provider Business Mailing Address
First Line	:	649 E BOSTON BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-1322
Country	:	US
Telephone Number	:	248-259-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	3311 12 MILE RD
Second Line	:
City	:	BERKLEY
State	:	MI
Zip	:	48072-1394
Country	:	US
Telephone Number	:	248-259-3203
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	12/05/2022

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