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General NPI Number Information
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NPI Number | 1013227560
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Entity Type | Individual
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Provider Name | DIANNA R TAIT LMT, BCTMB
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Gender | Female
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 08/22/2016
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Provider Practice Location Address
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Address Line | 1888 RIDGEVIEW
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City | YPSILANTI
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State | MI
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Zip | 48198-9490
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Country | US
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Telephone | 734-483-6994
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Fax | 734-971-1360
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Provider Business Mailing Address
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Address Line | 1888 RIDGEVIEW
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City | YPSILANTI
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State | MI
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Zip | 48198-9490
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Country | US
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Telephone | 734-483-6994
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Fax | 734-971-1360
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 530489-07
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 7501000286
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License Number State | MI
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