Provider Demographics
NPI:1003156332
Name:STOFFEL, SHELLEY MARY (CMT)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:MARY
Last Name:STOFFEL
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 BLACKSTOCK AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-5072
Mailing Address - Country:US
Mailing Address - Phone:414-331-1618
Mailing Address - Fax:
Practice Address - Street 1:516 BLACKSTOCK AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-5072
Practice Address - Country:US
Practice Address - Phone:414-331-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-23
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1115-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist