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General NPI Number Information
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NPI Number | 1093467805
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Entity Type | Individual
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Provider Name | SANDY STEVENS DCN, MT
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Gender | Female
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Dates
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Enumeration Date | 01/23/2022
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Last Update Date | 01/23/2022
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Provider Practice Location Address
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Address Line | 160 BENMONT AVE FL WING2
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City | BENNINGTON
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State | VT
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Zip | 05201-1873
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Country | US
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Telephone | 802-379-4159
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Fax |
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Provider Business Mailing Address
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Address Line | 311 WASHINGTON AVE
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City | BENNINGTON
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State | VT
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Zip | 05201-2362
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Country | US
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Telephone | 802-379-4159
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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