Individual
MS. CARLY JADE POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
216 ROYAL PARK LN, MADISON HEIGHTS, MI 48071-4520
(248) 632-6425
Mailing address
216 ROYAL PARK LN, MADISON HEIGHTS, MI 48071-4520
(248) 632-6425
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501011615
MI
Other
Enumeration date
09/09/2020
Last updated
09/09/2020
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