Individual
JESSICA MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT
Contact information
Practice address
24 W SHADBOLT ST, LAKE ORION, MI 48362-3170
(248) 287-2072
Mailing address
24 W SHADBOLT ST, LAKE ORION, MI 48362-3170
(248) 287-2072
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
578640-09
MI
Other
Enumeration date
11/01/2013
Last updated
06/20/2014
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