MEDICARE: MRS. NIKKEA CAMREN TODD LMT, MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	7501004130	MI

General Provider Information

NPI Number	:	1134589039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NIKKEA CAMREN TODD LMT, MBA

Provider Business Mailing Address
First Line	:	6405 SHERIDAN LINE RD
Second Line	:
City	:	CROSWELL
State	:	MI
Zip	:	48422-8341
Country	:	US
Telephone Number	:	858-271-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5590 MAIN ST STE 7
Second Line	:
City	:	LEXINGTON
State	:	MI
Zip	:	48450-9383
Country	:	US
Telephone Number	:	858-271-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2016
Last Update Date	:	03/04/2016

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