Provider Demographics
NPI:1497415541
Name:STAVES, DAKOTA LYNN (LICENSED MASSAGE THE)
Entity Type:Individual
Prefix:
First Name:DAKOTA
Middle Name:LYNN
Last Name:STAVES
Suffix:
Gender:F
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 W. GENESEE STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734
Mailing Address - Country:US
Mailing Address - Phone:989-652-2577
Mailing Address - Fax:989-652-4776
Practice Address - Street 1:526 W. GENESEE STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734
Practice Address - Country:US
Practice Address - Phone:989-652-2577
Practice Address - Fax:989-652-4776
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374700000X
MI7501015942225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374700000XNursing Service Related ProvidersTechnician