Healthcare Provider Details

I. General information

NPI: 1619808409
Provider Name (Legal Business Name): AUDREY ALYSSA KREINER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E NEPESSING ST
LAPEER MI
48446-2316
US

IV. Provider business mailing address

204 E NEPESSING ST
LAPEER MI
48446-2316
US

V. Phone/Fax

Practice location:
  • Phone: 810-356-4646
  • Fax:
Mailing address:
  • Phone: 810-356-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501017366
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: