Healthcare Provider Details

I. General information

NPI: 1851954408
Provider Name (Legal Business Name): BEVERLY FOSTER-MAXEY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17460 SALEM ST
DETROIT MI
48219-5802
US

IV. Provider business mailing address

17462 SALEM ST
DETROIT MI
48219-5802
US

V. Phone/Fax

Practice location:
  • Phone: 248-469-8480
  • Fax:
Mailing address:
  • Phone: 313-319-0694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501000137
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: