Healthcare Provider Details

I. General information

NPI: 1457754400
Provider Name (Legal Business Name): CHRISTIE KAY-ROSE COHEN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTIE KAY ROSE

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4994 PARK LAKE RD
EAST LANSING MI
48823-3836
US

IV. Provider business mailing address

4994 PARK LAKE RD
EAST LANSING MI
48823-3836
US

V. Phone/Fax

Practice location:
  • Phone: 517-391-7567
  • Fax:
Mailing address:
  • Phone: 517-391-7567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501003121
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: