Provider Demographics
NPI:1679613996
Name:PILLOW-WHITE, JENNIFER LEE (NCTM)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEE
Last Name:PILLOW-WHITE
Suffix:
Gender:F
Credentials:NCTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15698 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2387
Mailing Address - Country:US
Mailing Address - Phone:586-215-0729
Mailing Address - Fax:
Practice Address - Street 1:6022 W MAPLE RD
Practice Address - Street 2:SUITE 405
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4408
Practice Address - Country:US
Practice Address - Phone:248-737-8066
Practice Address - Fax:248-737-9093
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist