Provider Demographics
NPI:1295011849
Name:STANGEL, KATIE A (LMT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:A
Last Name:STANGEL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 GRAY RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4867
Mailing Address - Country:US
Mailing Address - Phone:207-592-8288
Mailing Address - Fax:
Practice Address - Street 1:108 TANDBERG TRAIL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062
Practice Address - Country:US
Practice Address - Phone:207-893-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT4603225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist