MEDICARE: CHRISTA ROSE STARKEY

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	103T00000X	Psychologist	2720103	MI
2	103TS0200X	School Psychologist	SP0000000772488	MI

General Provider Information

NPI Number	:	1922357557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTA ROSE STARKEY

Provider Business Mailing Address
First Line	:	614 HOWARD ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-7051
Country	:	US
Telephone Number	:	989-450-4694
Fax Number	:

Provider Business Practice Location Address
First Line	:	614 HOWARD ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-7051
Country	:	US
Telephone Number	:	989-450-4694
Fax Number	:

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

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	08/29/2012

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Directions to “ CHRISTA ROSE STARKEY ” Practice Location

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