Basic Information
| Provider Information | |||||||||
| NPI: | 1205013968 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHILDERS | ||||||||
| FirstName: | ALANNA | ||||||||
| MiddleName: | JEANNE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 TOWN CTR STE 2001 | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480751116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483520314 | ||||||||
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| Practice Location | |||||||||
| Address1: | 47100 SCHOENHERR RD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | SHELBY TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483154716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5866850505 | ||||||||
| FaxNumber: | 5866850501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2008 | ||||||||
| LastUpdateDate: | 01/20/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.