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General NPI Number Information
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NPI Number | 1497415541
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Entity Type | Individual
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Provider Name | DAKOTA LYNN STAVES LICENSED MASSAGE THE
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Gender | Female
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Dates
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Enumeration Date | 12/29/2021
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 3949 N RIVER RD
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City | FREELAND
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State | MI
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Zip | 48623-8856
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Country | US
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Telephone | 989-702-2082
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Fax |
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Provider Business Mailing Address
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Address Line | 3949 N RIVER RD
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City | FREELAND
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State | MI
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Zip | 48623-8856
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Country | US
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Telephone | 989-702-2082
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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 | 7501015942
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 374700000X
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Taxonomy Name | Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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