Provider Demographics
NPI:1841079365
Name:LAFOUNTAIN, ERICA LYNN (LMT)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:LAFOUNTAIN
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 1:406 UNION ST
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-2003
Mailing Address - Country:US
Mailing Address - Phone:269-993-1802
Mailing Address - Fax:
Practice Address - Street 1:557 LINCOLN RD STE A
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MI
Practice Address - Zip Code:49078-1080
Practice Address - Country:US
Practice Address - Phone:269-993-1802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501008172225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist