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General NPI Number Information
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NPI Number | 1669611513
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Entity Type | Individual
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Provider Name | REBECCA C STOLAREK
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Gender | Female
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Dates
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Enumeration Date | 02/17/2009
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Last Update Date | 02/17/2009
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Provider Practice Location Address
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Address Line | 319 DEMPSTER ST APT. 208
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City | EVANSTON
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State | IL
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Zip | 60201-4797
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Country | US
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Telephone | 847-733-0169
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Fax |
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Provider Business Mailing Address
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Address Line | 6313 N WAYNE AVE #2N
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City | CHICAGO
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State | IL
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Zip | 60660-1307
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Country | US
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Telephone | 773-544-2955
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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 | 227004136
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License Number State | IL
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