=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609350529
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATALIE GRACE CRAIG LMT, LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2018
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7008 MARY WAY
-----------------------------------------------------
City | THREE LAKES
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54562-9041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-544-5562
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7008 MARY WAY
-----------------------------------------------------
City | THREE LAKES
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54562-9041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-544-5562
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 14640
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------