Healthcare Provider Details

I. General information

NPI: 1881059970
Provider Name (Legal Business Name): ANNETTE GUZMAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41521 W 11 MILE RD
NOVI MI
48375
US

IV. Provider business mailing address

205 ROBIN RD SUITE 118
PARAMUS NJ
07652-1449
US

V. Phone/Fax

Practice location:
  • Phone: 248-299-0030
  • Fax:
Mailing address:
  • Phone: 201-225-1511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT00874400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: