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General NPI Number Information
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NPI Number | 1346596400
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Entity Type | Individual
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Provider Name | SHANE DENIS O'BRIEN
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Gender | Male
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Dates
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Enumeration Date | 07/26/2012
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Last Update Date | 07/26/2012
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Provider Practice Location Address
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Address Line | 201 1/2 E GRAND RIVER AVE SUITE 19
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City | EAST LANSING
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State | MI
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Zip | 48823-4323
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Country | US
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Telephone | 517-203-1113
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Fax |
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Provider Business Mailing Address
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Address Line | 1138 LONG LAKE DR
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City | BRIGHTON
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State | MI
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Zip | 48114-9641
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Country | US
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Telephone |
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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 |
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License Number State |
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