Provider Demographics
NPI:1205013968
Name:CHILDERS, ALANNA JEANNE (CMT)
Entity Type:Individual
Prefix:MS
First Name:ALANNA
Middle Name:JEANNE
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 TOWN CTR STE 2001
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-1116
Mailing Address - Country:US
Mailing Address - Phone:248-352-0314
Mailing Address - Fax:
Practice Address - Street 1:47100 SCHOENHERR RD
Practice Address - Street 2:SUITE D
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-4716
Practice Address - Country:US
Practice Address - Phone:586-685-0505
Practice Address - Fax:586-685-0501
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist