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General NPI Number Information
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NPI Number | 1093813081
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Entity Type | Individual
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Provider Name | STACEY LYNN FELLINGER L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 10/22/2008
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Provider Practice Location Address
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Address Line | 9002 MENTOR AVE
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City | MENTOR
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State | OH
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Zip | 44060-6302
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Country | US
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Telephone | 440-266-1901
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Fax | 440-266-1902
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Provider Business Mailing Address
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Address Line | 1099 HILLROCK DR
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City | SOUTH EUCLID
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State | OH
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Zip | 44121-3852
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Country | US
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Telephone | 216-381-8110
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Fax | 216-297-9200
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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 | 8407
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License Number State | OH
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