MEDICARE: GRACE MAYES

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	7501001828	MI

General Provider Information

NPI Number	:	1730612623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE MAYES

Provider Business Mailing Address
First Line	:	2450 44TH ST SE
Second Line	:	SUITE 205
City	:	KENTWOOD
State	:	MI
Zip	:	49512-9081
Country	:	US
Telephone Number	:	616-438-1204
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 44TH ST SE
Second Line	:	SUITE 205
City	:	KENTWOOD
State	:	MI
Zip	:	49512-9081
Country	:	US
Telephone Number	:	616-438-1204
Fax Number	:

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

Provider Enumeration Date	:	04/06/2017
Last Update Date	:	04/06/2017

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Directions to “ GRACE MAYES ” Practice Location

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