Individual
MRS. JEANETTE L LILLYSTONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
1669 W MAPLE RD, BIRMINGHAM, MI 48009-1230
(248) 646-3347
Mailing address
136 S WILSON AVE, ROYAL OAK, MI 48067-2945
(248) 398-4858
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
—
MI
Other
Enumeration date
03/14/2011
Last updated
03/15/2011
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