Healthcare Provider Details

I. General information

NPI: 1952150179
Provider Name (Legal Business Name): KAREN FARIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 PLAINFIELD AVE NE STE B
GRAND RAPIDS MI
49525-1059
US

IV. Provider business mailing address

1047 DALLAS AVE SE
GRAND RAPIDS MI
49507-1407
US

V. Phone/Fax

Practice location:
  • Phone: 616-874-7909
  • Fax:
Mailing address:
  • Phone: 360-266-7537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501015167
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: