Healthcare Provider Details

I. General information

NPI: 1457524225
Provider Name (Legal Business Name): STACEY LEE DOBEK CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 MAIN ST
MIDDLEBURY VT
05753-1426
US

IV. Provider business mailing address

484 MILL RD
LINCOLN VT
05443-9691
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-0414
  • Fax:
Mailing address:
  • Phone: 802-453-2825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: