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General NPI Number Information
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NPI Number | 1629433909
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Entity Type | Individual
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Provider Name | ROSE MCCABE
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Gender | Female
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Dates
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Enumeration Date | 12/30/2015
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Last Update Date | 12/30/2015
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Provider Practice Location Address
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Address Line | 2245 S ORTONVILLE RD
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City | ORTONVILLE
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State | MI
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Zip | 48462-8548
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Country | US
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Telephone | 248-420-5492
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Fax |
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Provider Business Mailing Address
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Address Line | 4585 GROVELAND RD
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City | ORTONVILLE
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State | MI
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Zip | 48462-9022
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Country | US
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Telephone | 248-420-5492
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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 | L2503024
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License Number State | MI
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