Healthcare Provider Details

I. General information

NPI: 1780916320
Provider Name (Legal Business Name): RENEE RUTH DESVOIGNES CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 N 10TH ST SUITE110
KALAMAZOO MI
49009-5733
US

IV. Provider business mailing address

PO BOX 2588
PORTAGE MI
49081-2588
US

V. Phone/Fax

Practice location:
  • Phone: 269-375-4363
  • Fax: 269-375-4362
Mailing address:
  • Phone: 269-375-4363
  • Fax: 269-375-4362

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: