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General NPI Number Information
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NPI Number | 1093293458
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Entity Type | Individual
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Provider Name | JENNIFER L SIWEK LMT
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Gender | Female
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Dates
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Enumeration Date | 07/29/2018
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Last Update Date | 07/29/2018
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Provider Practice Location Address
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Address Line | 2193 ASSOCIATION DR STE 700
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City | OKEMOS
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State | MI
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Zip | 48864-4904
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Country | US
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Telephone | 517-282-2910
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Fax |
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Provider Business Mailing Address
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Address Line | 3714 INVERARY DR
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City | LANSING
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State | MI
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Zip | 48911-1338
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Country | US
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Telephone | 517-282-2910
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Fax |
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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 | 7501004220
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License Number State | MI
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