Provider Demographics
NPI:1669215224
Name:WARD, MARIAH CHRISTIE (LMT)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:CHRISTIE
Last Name:WARD
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 1:407 LAKEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-3129
Mailing Address - Country:US
Mailing Address - Phone:313-718-3650
Mailing Address - Fax:
Practice Address - Street 1:4401 CONNER ST, DETROIT, MI 43215
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215
Practice Address - Country:US
Practice Address - Phone:313-306-7279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501004198225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist