Provider Demographics
NPI:1871989509
Name:HOCKINGS, SUSAN (LMT, BCTMB)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HOCKINGS
Suffix:
Gender:F
Credentials:LMT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12886 HIGHWAY M26
Mailing Address - Street 2:
Mailing Address - City:EAGLE HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49950-9515
Mailing Address - Country:US
Mailing Address - Phone:906-289-4001
Mailing Address - Fax:
Practice Address - Street 1:12886 HIGHWAY M26
Practice Address - Street 2:
Practice Address - City:EAGLE HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49950-9515
Practice Address - Country:US
Practice Address - Phone:906-289-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501003618225700000X
WI4094-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist