Provider Demographics
NPI:1568977023
Name:INTERLUDE MASSAGE AND WELLNESS
Entity Type:Organization
Organization Name:INTERLUDE MASSAGE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:989-289-0969
Mailing Address - Street 1:3387 N CLARE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:MI
Mailing Address - Zip Code:48625-9693
Mailing Address - Country:US
Mailing Address - Phone:989-289-0969
Mailing Address - Fax:
Practice Address - Street 1:3387 N CLARE AVE STE 101
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:MI
Practice Address - Zip Code:48625-9693
Practice Address - Country:US
Practice Address - Phone:989-289-0969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501010072225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty