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General NPI Number Information
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NPI Number | 1770390262
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Entity Type | Individual
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Provider Name | STACEY DOUCETTE
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Gender | Female
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 873 CLARE LN
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City | YORK
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State | PA
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Zip | 17402-4317
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Country | US
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Telephone | 717-840-3232
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Fax |
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Provider Business Mailing Address
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Address Line | 12 VIRGINIA AVE
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City | SHREWSBURY
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State | PA
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Zip | 17361-1911
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Country | US
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Telephone |
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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 | M05778
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License Number State | MD
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