Provider Demographics
NPI:1174011555
Name:BATEMAN, RHEANNON (LMT, HT (ASCP))
Entity Type:Individual
Prefix:
First Name:RHEANNON
Middle Name:
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:LMT, HT (ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3969 AURELIUS RD
Mailing Address - Street 2:
Mailing Address - City:ONONDAGA
Mailing Address - State:MI
Mailing Address - Zip Code:49264-9720
Mailing Address - Country:US
Mailing Address - Phone:517-449-4858
Mailing Address - Fax:
Practice Address - Street 1:780 W LAKE LANSING RD STE 400
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8452
Practice Address - Country:US
Practice Address - Phone:517-575-6362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501007006225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist