MEDICARE: SUSAN KAUGHER 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	7501004776	MI

General Provider Information

NPI Number	:	1922404060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN KAUGHER LMT

Provider Business Mailing Address
First Line	:	715 RIVER PARK VILLAGE BLVD
Second Line	:
City	:	NORTHVILLE
State	:	MI
Zip	:	48167-2777
Country	:	US
Telephone Number	:	248-444-7142
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 RIVER PARK VILLAGE BLVD
Second Line	:
City	:	NORTHVILLE
State	:	MI
Zip	:	48167-2777
Country	:	US
Telephone Number	:	248-444-7142
Fax Number	:

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

Provider Enumeration Date	:	11/18/2014
Last Update Date	:	11/18/2014

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