Healthcare Provider Details

I. General information

NPI: 1578573374
Provider Name (Legal Business Name): KARINA SARAH SUZANNE HENRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 N NEEPER ST
CAPAC MI
48014-3036
US

IV. Provider business mailing address

308 N NEEPER
CAPAC MI
48014
US

V. Phone/Fax

Practice location:
  • Phone: 810-966-2570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: