Individual
MISS CLARISSA MICHELLE HENTSCHEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4150 KALAMAZOO AVE SE, GRAND RAPIDS, MI 49508-3605
(616) 913-2006
Mailing address
411 122ND AVE, SHELBYVILLE, MI 49344-9755
(269) 251-6728
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502008620
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5502008620
—
MI
Enumeration date
08/05/2024
Last updated
08/05/2024
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