Healthcare Provider Details

I. General information

NPI: 1568371847
Provider Name (Legal Business Name): SHALON OPAL STRONG LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12719 RILEY ST STE 80
HOLLAND MI
49424-9216
US

IV. Provider business mailing address

13605 CLEARWATER LN
GRAND HAVEN MI
49417-9553
US

V. Phone/Fax

Practice location:
  • Phone: 616-738-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501017458
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: