| Organization Name: | ELECTRO SPA OF NORTHERN MICHIGAN |
| NPI Number: | 1013239185 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARGUERITE J TILLEY (CLINICIAN) |
| Mailing Address: | 403 E State St Ste 100 Traverse City |
| State: | MI US |
| Postal Code: | 496865805 |
| Phone Number: | 2319336001 |
| Fax Number: | 2319471506 |
| NPI Enumeration Date: | 02/17/2010 |
| NPI Last Update Date: | 02/17/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Specialist/Technologist, Other |
| Taxonomy Specialization: | |
| Taxonomy Definition: | General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines. |