Provider Demographics
NPI:1275126500
Name:CALVELAGE, STACY MARIE (MT)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:MARIE
Last Name:CALVELAGE
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 523
Mailing Address - Street 2:
Mailing Address - City:OTTOVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45876-0523
Mailing Address - Country:US
Mailing Address - Phone:419-234-3304
Mailing Address - Fax:
Practice Address - Street 1:330 E 4TH ST
Practice Address - Street 2:
Practice Address - City:OTTOVILLE
Practice Address - State:OH
Practice Address - Zip Code:45876-8715
Practice Address - Country:US
Practice Address - Phone:419-234-3304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.011989225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist