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General NPI Number Information
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NPI Number | 1821961087
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Entity Type | Organization
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Legal Business Name | UNEVEN LOTUS YOGA, LLC
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Dates
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Enumeration Date | 09/24/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 355 48TH ST SE
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City | KENTWOOD
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State | MI
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Zip | 49548-4407
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Country | US
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Telephone | 616-805-9195
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Fax |
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Provider Business Mailing Address
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Address Line | 5935 CRESTMOOR DR SE
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City | KENTWOOD
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State | MI
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Zip | 49508-6511
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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 | REGISTERED YOGA TEACHER
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Name | ANGELA GOLLADAY
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Credential | ERYT200, YACEP
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Telephone | 616-805-9195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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