Basic Information
| Provider Information | |||||||||
| NPI: | 1184856536 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | MT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | WOTHERSPOON | ||||||||
| OtherFirstName: | ERIN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5000 TOWN CTR APT 2001 | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480751116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5866850505 | ||||||||
| FaxNumber: | 5866850501 | ||||||||
| Practice Location | |||||||||
| Address1: | 47100 SCHOENHERR RD STE D | ||||||||
| Address2: | |||||||||
| City: | SHELBY TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483154714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5866850505 | ||||||||
| FaxNumber: | 5866850501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2009 | ||||||||
| LastUpdateDate: | 10/21/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.