Healthcare Provider Details

I. General information

NPI: 1184598724
Provider Name (Legal Business Name): AMANDA MEKKES LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA MORROW

II. Dates (important events)

Enumeration Date: 10/04/2025
Last Update Date: 10/04/2025
Certification Date: 10/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 S STATE ST
SPARTA MI
49345-1547
US

IV. Provider business mailing address

542 S STATE ST
SPARTA MI
49345-1547
US

V. Phone/Fax

Practice location:
  • Phone: 616-887-2178
  • Fax:
Mailing address:
  • Phone: 616-887-2178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number750100940
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: