Provider Demographics
NPI:1518655968
Name:CLOUTIER, TAMMY JO (CMT)
Entity Type:Individual
Prefix:MISS
First Name:TAMMY
Middle Name:JO
Last Name:CLOUTIER
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:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:COPPER HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49918-0096
Mailing Address - Country:US
Mailing Address - Phone:906-281-0969
Mailing Address - Fax:
Practice Address - Street 1:747 GRATIOT ST
Practice Address - Street 2:
Practice Address - City:COPPER HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49918-5109
Practice Address - Country:US
Practice Address - Phone:906-281-0969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501005181225A00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist