Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | ||
Y | 225700000X | Massage Therapist | 7501003284 | MI |
NPI | 1013426113 |
---|---|
Provider Name | Julie Chellis |
First Address | Petoskey, MI 49770-8891 |
Second Address | Petoskey, MI 49770-8891 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2017 |
Last Update Date | 21/09/2017 |