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NPI Code Detail

MEDICARE: JACLYN MARIE DOERR

MEDICARE: JACLYN MARIE DOERR
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
1225700000XMassage TherapistL171512MI

General Provider Information

NPI Number : 1215354782
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACLYN MARIE DOERR
Provider Business Mailing Address
First Line : 15116 ARCOLA ST
Second Line :
City : LIVONIA
State : MI
Zip : 48154-3928
Country : US
Telephone Number : 734-233-8020
Fax Number :
Provider Business Practice Location Address
First Line : 35560 GRAND RIVER AVE
Second Line : SUITE 225
City : FARMINGTON HILLS
State : MI
Zip : 48335-3123
Country : US
Telephone Number : 734-276-3424
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2014
Last Update Date : 03/23/2014

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Directions to “ JACLYN MARIE DOERR ” Practice Location

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