Provider Demographics
NPI:1093574006
Name:OEFTERING, WILLIAM R (LMT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:OEFTERING
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23048 N BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-2317
Mailing Address - Country:US
Mailing Address - Phone:313-717-6973
Mailing Address - Fax:
Practice Address - Street 1:201 RUBLEIN ST STE A
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4060
Practice Address - Country:US
Practice Address - Phone:906-226-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501014216225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist