Provider Demographics
NPI:1225215585
Name:MAIS, PATRICIA LEA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LEA
Last Name:MAIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:SCHOOLCRAFT
Mailing Address - State:MI
Mailing Address - Zip Code:49087-0337
Mailing Address - Country:US
Mailing Address - Phone:269-679-5530
Mailing Address - Fax:269-679-5530
Practice Address - Street 1:115 S GRAND ST
Practice Address - Street 2:
Practice Address - City:SCHOOLCRAFT
Practice Address - State:MI
Practice Address - Zip Code:49087-9499
Practice Address - Country:US
Practice Address - Phone:269-679-5530
Practice Address - Fax:269-679-5530
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3222441Medicaid
MI3222441Medicaid