Healthcare Provider Details

I. General information

NPI: 1275260598
Provider Name (Legal Business Name): TAMMY LYNN TROTT MT, DOM, LIC. ACUP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 ASHER CT STE 100
EAST LANSING MI
48823-8444
US

IV. Provider business mailing address

14082 REED RD
BYRON MI
48418-8889
US

V. Phone/Fax

Practice location:
  • Phone: 517-351-9240
  • Fax: 517-351-9242
Mailing address:
  • Phone: 505-930-2494
  • Fax: 517-351-9242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number5402000170
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501011175
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: