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General NPI Number Information
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NPI Number | 1508376831
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Entity Type | Individual
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Provider Name | TAMA C MACKAY LMT, ART, CKTP
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Gender | Female
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Dates
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Enumeration Date | 09/29/2017
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 23 RADIO PL
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City | STAMFORD
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State | CT
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Zip | 06906-2219
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Country | US
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Telephone | 203-998-5826
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Fax |
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Provider Business Mailing Address
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Address Line | 20 BERKELEY TER
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City | MILFORD
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State | CT
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Zip | 06460-4919
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Country | US
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Telephone | 203-747-4485
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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 | 008668
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License Number State | CT
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