Healthcare Provider Details

I. General information

NPI: 1629512637
Provider Name (Legal Business Name): HEATHER AMBER-SHAFT HANTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 W LAKE LANSING RD
EAST LANSING MI
48823-8474
US

IV. Provider business mailing address

780 W LAKE LANSING RD
EAST LANSING MI
48823-8474
US

V. Phone/Fax

Practice location:
  • Phone: 616-920-0271
  • Fax: 517-575-6362
Mailing address:
  • Phone: 616-920-0271
  • Fax: 517-575-6362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501000521
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: