Provider Demographics
NPI:1811411010
Name:HOWARD, AUTUMN FAWN I
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:FAWN
Last Name:HOWARD
Suffix:I
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 1:1800 E JORDAN RD LOT 1
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9746
Mailing Address - Country:US
Mailing Address - Phone:989-560-4661
Mailing Address - Fax:
Practice Address - Street 1:1800 E JORDAN RD LOT 1
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-9746
Practice Address - Country:US
Practice Address - Phone:989-560-4661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502001683225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant