Provider Demographics
NPI:1073081964
Name:DOMPKE, JANICE KAY (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:KAY
Last Name:DOMPKE
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ASHFIELD ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01370-1415
Mailing Address - Country:US
Mailing Address - Phone:413-559-8324
Mailing Address - Fax:413-625-2270
Practice Address - Street 1:1 ASHFIELD ST STE 4
Practice Address - Street 2:
Practice Address - City:SHELBURNE FALLS
Practice Address - State:MA
Practice Address - Zip Code:01370-1415
Practice Address - Country:US
Practice Address - Phone:413-559-8324
Practice Address - Fax:413-625-2270
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13392225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist