MEDICARE: MRS. KIMBERLY ANN CONNIFF LMT

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		MI

General Provider Information

NPI Number	:	1194050385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY ANN CONNIFF LMT

Provider Business Mailing Address
First Line	:	1147 E LONG LAKE RD
Second Line	:	SUITE #2
City	:	TROY
State	:	MI
Zip	:	48085-4943
Country	:	US
Telephone Number	:	248-918-4898
Fax Number	:	248-250-5660

Provider Business Practice Location Address
First Line	:	1147 E LONG LAKE RD
Second Line	:	SUITE #2
City	:	TROY
State	:	MI
Zip	:	48085-4943
Country	:	US
Telephone Number	:	248-918-4898
Fax Number	:

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

Provider Enumeration Date	:	10/06/2009
Last Update Date	:	04/18/2013

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