Healthcare Provider Details

I. General information

NPI: 1427061050
Provider Name (Legal Business Name): MARILYN ROTKO MA, NCMMT, NCTMB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26711 WOODWARD AVE SUITE LL4
HUNTINGTON WOODS MI
48070-1333
US

IV. Provider business mailing address

26711 WOODWARD AVE SUITE LL4
HUNTINGTON WOODS MI
48070-1333
US

V. Phone/Fax

Practice location:
  • Phone: 248-542-3390
  • Fax: 248-542-7659
Mailing address:
  • Phone: 248-542-3390
  • Fax: 248-542-7659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: