Provider Demographics
NPI:1407134216
Name:HAYNES, MICHELE (NCTM)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:NCTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15208 BERWICK ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3554
Mailing Address - Country:US
Mailing Address - Phone:734-524-0388
Mailing Address - Fax:
Practice Address - Street 1:15208 BERWICK ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3554
Practice Address - Country:US
Practice Address - Phone:734-524-0388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist