Healthcare Provider Details

I. General information

NPI: 1346153467
Provider Name (Legal Business Name): HAILEY KOPROWICZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 BURTON ST SE
GRAND RAPIDS MI
49507-3367
US

IV. Provider business mailing address

945 CALIFORNIA ST NW
GRAND RAPIDS MI
49504-6364
US

V. Phone/Fax

Practice location:
  • Phone: 616-304-9295
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501016426
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: