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General NPI Number Information
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NPI Number | 1912437518
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Entity Type | Organization
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Legal Business Name | DIVONNE TOUCH
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Dates
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Enumeration Date | 06/15/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 18298 MIDDLEBELT
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City | LIVIONA
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State | MI
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Zip | 48152
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Country | US
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Telephone | 248-383-3852
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Fax |
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Provider Business Mailing Address
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Address Line | 18298 MIDDLEBELT RD
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City | LIVONIA
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State | MI
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Zip | 48152-5007
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Country | US
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Telephone | 248-383-3852
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | CIARA BEARD
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Credential |
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Telephone | 248-383-3852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 7501002710
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License Number State | MI
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