Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 1115-146 | WI |
NPI | 1003156332 |
---|---|
Provider Name | Ms. Shelley Mary Stoffel |
First Address | Sheboygan, WI 53083-5072 |
Second Address | Sheboygan, WI 53083-5072 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2013 |
Last Update Date | 23/02/2013 |