Provider Demographics
NPI:1497492789
Name:GATLIN, MICHELLE RENE (LMT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENE
Last Name:GATLIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1656 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3024
Mailing Address - Country:US
Mailing Address - Phone:661-426-4377
Mailing Address - Fax:
Practice Address - Street 1:1656 OAK ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3024
Practice Address - Country:US
Practice Address - Phone:661-426-4377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA48619225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist