Provider Demographics
NPI:1093813081
Name:FELLINGER, STACEY LYNN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LYNN
Last Name:FELLINGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:LYNN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1099 HILLROCK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3852
Mailing Address - Country:US
Mailing Address - Phone:216-381-8110
Mailing Address - Fax:216-297-9200
Practice Address - Street 1:9002 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6302
Practice Address - Country:US
Practice Address - Phone:440-266-1901
Practice Address - Fax:440-266-1902
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8407225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist