Healthcare Provider Details

I. General information

NPI: 1407625627
Provider Name (Legal Business Name): MARIE LOUISE STOCKER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE LOUISE ROBINSON LMT

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 30TH ST NE
CANTON OH
44714-1404
US

IV. Provider business mailing address

411 15TH ST NW
CANTON OH
44703-1722
US

V. Phone/Fax

Practice location:
  • Phone: 330-491-0381
  • Fax:
Mailing address:
  • Phone: 330-605-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.021228
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: