Provider Demographics
NPI:1669811162
Name:AMERSON, LATINA JENNIFER (CMT)
Entity type:Individual
Prefix:MS
First Name:LATINA
Middle Name:JENNIFER
Last Name:AMERSON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10195 DIANE ST APT 304
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-3322
Mailing Address - Country:US
Mailing Address - Phone:313-748-5452
Mailing Address - Fax:
Practice Address - Street 1:2804 ORCHARD LAKE RD STE 209
Practice Address - Street 2:
Practice Address - City:KEEGO HARBOR
Practice Address - State:MI
Practice Address - Zip Code:48320-1449
Practice Address - Country:US
Practice Address - Phone:248-499-8216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist