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General NPI Number Information
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NPI Number | 1396099453
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Entity Type | Individual
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Provider Name | KATHERINE MARIE MCLEOD C.M.T.
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Gender | Female
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Dates
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Enumeration Date | 10/28/2012
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Last Update Date | 10/28/2012
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Provider Practice Location Address
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Address Line | 15635 W 12 MILE RD SUITE #110
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City | SOUTHFIELD
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State | MI
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Zip | 48076-3048
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Country | US
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Telephone | 248-559-9995
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Fax | 248-559-9995
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Provider Business Mailing Address
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Address Line | 15635 W 12 MILE RD SUITE #110
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City | SOUTHFIELD
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State | MI
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Zip | 48076-3048
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Country | US
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Telephone | 248-559-9995
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Fax | 248-559-9995
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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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