Provider Demographics
NPI:1922404060
Name:KAUGHER, SUSAN (LMT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KAUGHER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 RIVER PARK VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2777
Mailing Address - Country:US
Mailing Address - Phone:248-444-7142
Mailing Address - Fax:
Practice Address - Street 1:715 RIVER PARK VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2777
Practice Address - Country:US
Practice Address - Phone:248-444-7142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501004776225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist