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General NPI Number Information
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NPI Number | 1023400553
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Entity Type | Organization
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Legal Business Name | TRANQUIL TRAILS DOULA
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Dates
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Enumeration Date | 02/20/2015
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Last Update Date | 02/20/2015
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Provider Practice Location Address
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Address Line | 4694 TOLLAND AVE
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City | HOLT
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State | MI
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Zip | 48842-1128
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Country | US
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Telephone | 517-906-6913
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Fax |
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Provider Business Mailing Address
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Address Line | 4694 TOLLAND AVE
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City | HOLT
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State | MI
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Zip | 48842-1128
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Country | US
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Telephone | 517-906-6913
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LIANNE R CLOUGH
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Credential |
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Telephone | 517-906-6913
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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 | 7501001724
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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