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General NPI Number Information
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NPI Number | 1316285604
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Entity Type | Individual
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Provider Name | STEPHANIE GABRIELLE ROOT DICKEY LMP
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Gender | Female
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Dates
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Enumeration Date | 01/22/2013
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Last Update Date | 01/22/2013
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Provider Practice Location Address
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Address Line | 1002 LAWRENCE ST
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City | PORT TOWNSEND
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State | WA
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Zip | 98368-6524
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Country | US
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Telephone | 360-643-0092
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26
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City | PORT HADLOCK
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State | WA
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Zip | 98339-0026
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Country | US
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Telephone | 360-643-0092
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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 | MA60180770
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License Number State | WA
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