Individual
MRS. AUTUMN N BAHLKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3010 WILSON AVE SW, GRANDVILLE, MI 49418-1242
(616) 249-8141
Mailing address
3010 WILSON AVE SW, GRANDVILLE, MI 49418-1242
(616) 249-8141
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501003583
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7501003583
NA
MI
Enumeration date
06/08/2020
Last updated
06/08/2020
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