MEDICARE: TONIA LYNN MAITLAND

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	AF250065418	MI

General Provider Information

NPI Number	:	1356417034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONIA LYNN MAITLAND

Provider Business Mailing Address
First Line	:	12237 MARSHALL RD
Second Line	:
City	:	MONTROSE
State	:	MI
Zip	:	48457-8802
Country	:	US
Telephone Number	:	810-639-6386
Fax Number	:

Provider Business Practice Location Address
First Line	:	12237 MARSHALL RD
Second Line	:
City	:	MONTROSE
State	:	MI
Zip	:	48457-8802
Country	:	US
Telephone Number	:	810-639-6386
Fax Number	:

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	07/08/2007

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Directions to “ TONIA LYNN MAITLAND ” Practice Location

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