Provider Demographics
NPI:1720413131
Name:WELLS, SEIDAH
Entity Type:Individual
Prefix:
First Name:SEIDAH
Middle Name:
Last Name:WELLS
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 1:20812 ORCHARD LAKE RD
Mailing Address - Street 2:204
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5266
Mailing Address - Country:US
Mailing Address - Phone:248-767-7754
Mailing Address - Fax:
Practice Address - Street 1:20812 ORCHARD LAKE RD
Practice Address - Street 2:204
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5266
Practice Address - Country:US
Practice Address - Phone:248-767-7754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist