Provider Demographics
NPI:1629401674
Name:PROUTY, KATHY ANNE
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:ANNE
Last Name:PROUTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 KENSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-2803
Mailing Address - Country:US
Mailing Address - Phone:517-898-6958
Mailing Address - Fax:
Practice Address - Street 1:1780 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4998
Practice Address - Country:US
Practice Address - Phone:517-898-6958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist