Provider Demographics
NPI:1518437979
Name:CHAMPION, ANNE M (LMT, OMT, MMP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:LMT, OMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 JONES ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-9708
Mailing Address - Country:US
Mailing Address - Phone:586-610-6810
Mailing Address - Fax:
Practice Address - Street 1:193 JONES ST APT 1
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-9708
Practice Address - Country:US
Practice Address - Phone:248-662-8666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501010009225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist