Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | CFO05134 | MI |
N | 225700000X | Massage Therapist | 7501001981 | MI |
NPI | 1013514280 |
---|---|
Provider Name | Natalie Marie Roesler |
First Address | Montague, MI 49437-1222 |
Second Address | Muskegon, MI 49444-1833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2020 |
Last Update Date | 01/10/2020 |