Provider Demographics
NPI:1386000628
Name:SANTIAGO, MICHELE (LMBT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 PINEHURST AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-7138
Mailing Address - Country:US
Mailing Address - Phone:910-690-9955
Mailing Address - Fax:910-684-8634
Practice Address - Street 1:275 PINEHURST AVE STE B
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7138
Practice Address - Country:US
Practice Address - Phone:910-690-9955
Practice Address - Fax:910-684-8634
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1448225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist