MEDICARE: CHRISTIE KAY-ROSE COHEN 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	7501003121	MI

General Provider Information

NPI Number	:	1457754400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIE KAY-ROSE COHEN LMT

Provider Business Mailing Address
First Line	:	4994 PARK LAKE RD
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-3836
Country	:	US
Telephone Number	:	517-391-7567
Fax Number	:

Provider Business Practice Location Address
First Line	:	4994 PARK LAKE RD
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-3836
Country	:	US
Telephone Number	:	517-391-7567
Fax Number	:

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

Provider Enumeration Date	:	10/06/2014
Last Update Date	:	10/06/2014

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