MEDICARE: WESLEY VALLETTE

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	7501010619	MI

General Provider Information

NPI Number	:	1649743071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WESLEY VALLETTE

Provider Business Mailing Address
First Line	:	2480 CASS LAKE RD
Second Line	:
City	:	KEEGO HARBOR
State	:	MI
Zip	:	48320-1421
Country	:	US
Telephone Number	:	248-330-9416
Fax Number	:

Provider Business Practice Location Address
First Line	:	3181 ORCHARD LAKE RD
Second Line	:
City	:	KEEGO HARBOR
State	:	MI
Zip	:	48320-1250
Country	:	US
Telephone Number	:	248-330-9416
Fax Number	:

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

Provider Enumeration Date	:	01/08/2019
Last Update Date	:	01/08/2019

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Directions to “ WESLEY VALLETTE ” Practice Location

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