Provider Demographics
NPI:1144081068
Name:DEAN, KIRSTEN E (LMT)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:E
Last Name:DEAN
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 1:209 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-3613
Mailing Address - Country:US
Mailing Address - Phone:810-858-7071
Mailing Address - Fax:
Practice Address - Street 1:206 SALZBURG AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-5387
Practice Address - Country:US
Practice Address - Phone:989-262-9044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501014512225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist