Provider Demographics
NPI:1457754400
Name:COHEN, CHRISTIE KAY-ROSE (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:KAY-ROSE
Last Name:COHEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:KAY
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4994 PARK LAKE RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-3836
Mailing Address - Country:US
Mailing Address - Phone:517-391-7567
Mailing Address - Fax:
Practice Address - Street 1:4994 PARK LAKE RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3836
Practice Address - Country:US
Practice Address - Phone:517-391-7567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501003121225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist