Provider Demographics
NPI:1629512637
Name:HANTON, HEATHER AMBER-SHAFT
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:AMBER-SHAFT
Last Name:HANTON
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 1:780 W LAKE LANSING RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8474
Mailing Address - Country:US
Mailing Address - Phone:616-920-0271
Mailing Address - Fax:517-575-6362
Practice Address - Street 1:780 W LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8474
Practice Address - Country:US
Practice Address - Phone:616-920-0271
Practice Address - Fax:517-575-6362
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501000521225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist