Healthcare Provider Details

I. General information

NPI: 1417462102
Provider Name (Legal Business Name): RACHEL JEAN PATTINSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL JEAN PATTINSON

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4468 W WALTON BLVD STE C
WATERFORD MI
48329-4098
US

IV. Provider business mailing address

4468 W WALTON BLVD STE C
WATERFORD MI
48329-4098
US

V. Phone/Fax

Practice location:
  • Phone: 810-691-6005
  • Fax:
Mailing address:
  • Phone: 810-691-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501008276
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: