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General NPI Number Information
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NPI Number | 1134856545
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Entity Type | Individual
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Provider Name | SABRINA STACKHOUSE MT
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Gender | Female
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 27 SAINT MICHAELS DR
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City | BOURBONNAIS
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State | IL
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Zip | 60914-9106
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Country | US
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Telephone | 815-523-7656
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Fax | 815-793-6353
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Provider Business Mailing Address
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Address Line | 27 SAINT MICHAELS DR APT SUITE
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City | BOURBONNAIS
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State | IL
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Zip | 60914-9106
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Country | US
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Telephone | 815-793-6354
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Fax | 815-523-7656
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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 | 227017071
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License Number State | IL
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