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General NPI Number Information
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NPI Number | 1124473814
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Entity Type | Organization
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Legal Business Name | BODY BLISS LLC
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Dates
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Enumeration Date | 04/29/2016
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Last Update Date | 04/29/2016
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Provider Practice Location Address
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Address Line | 7355 LEWIS AVE SUITE B
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City | TEMPERANCE
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State | MI
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Zip | 48182-1465
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Country | US
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Telephone | 734-224-0621
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Fax |
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Provider Business Mailing Address
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Address Line | 7355 LEWIS AVE SUITE B
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City | TEMPERANCE
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State | MI
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Zip | 48182-1465
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Country | US
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Telephone | 734-224-0621
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KELLIE SUE ENGLAND
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Credential | LMT, NCMT, CST
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Telephone | 734-224-0621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 7501004627
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 7501000854
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License Number State | MI
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