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NPI Code Detail

MEDICARE: MRS. STACEY LYNN FELLINGER L.M.T.

MEDICARE: MRS. STACEY LYNN FELLINGER L.M.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist8407OH

General Provider Information

NPI Number : 1093813081
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STACEY LYNN FELLINGER L.M.T.
Provider Business Mailing Address
First Line : 1099 HILLROCK DR
Second Line :
City : SOUTH EUCLID
State : OH
Zip : 44121-3852
Country : US
Telephone Number : 216-381-8110
Fax Number : 216-297-9200
Provider Business Practice Location Address
First Line : 9002 MENTOR AVE
Second Line :
City : MENTOR
State : OH
Zip : 44060-6302
Country : US
Telephone Number : 440-266-1901
Fax Number : 440-266-1902
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 10/22/2008

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