Provider Demographics
NPI:1457784456
Name:CHAMPAGNE, ERIKA DAWN (MT)
Entity Type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:DAWN
Last Name:CHAMPAGNE
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30759 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-5060
Mailing Address - Country:US
Mailing Address - Phone:734-634-1440
Mailing Address - Fax:
Practice Address - Street 1:819 N MILL ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2189
Practice Address - Country:US
Practice Address - Phone:734-416-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist