Healthcare Provider Details

I. General information

NPI: 1306347224
Provider Name (Legal Business Name): CAITLIN DENISE EMMERSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W 14 MILE RD STE B2
CLAWSON MI
48017-3100
US

IV. Provider business mailing address

555 W 14 MILE RD STE B2
CLAWSON MI
48017-3100
US

V. Phone/Fax

Practice location:
  • Phone: 248-733-3885
  • Fax:
Mailing address:
  • Phone: 248-733-3885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501009209
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: