Provider Demographics
NPI:1346578283
Name:STENSON, AUDREY ELITA (CMT)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ELITA
Last Name:STENSON
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 1:239 FITCH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNACE
Mailing Address - State:MI
Mailing Address - Zip Code:49781-1631
Mailing Address - Country:US
Mailing Address - Phone:906-643-8867
Mailing Address - Fax:
Practice Address - Street 1:239 FITCH ST
Practice Address - Street 2:
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781-1631
Practice Address - Country:US
Practice Address - Phone:906-643-8867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist