Healthcare Provider Details

I. General information

NPI: 1134051899
Provider Name (Legal Business Name): JENNIFER ELYSE COHON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 W MAPLE RD UNIT A
WEST BLOOMFIELD MI
48322-4302
US

IV. Provider business mailing address

7659 PARK MEADOW LN
WEST BLOOMFIELD MI
48324-4104
US

V. Phone/Fax

Practice location:
  • Phone: 248-562-7846
  • Fax:
Mailing address:
  • Phone: 248-840-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501001453
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: