Provider Demographics
NPI:1942690185
Name:STOAKS, KATIE (LMT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:STOAKS
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 1:1925 SHADY OAK DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-1692
Mailing Address - Country:US
Mailing Address - Phone:231-557-2869
Mailing Address - Fax:
Practice Address - Street 1:8724 FERRY ST
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:MI
Practice Address - Zip Code:49437-1210
Practice Address - Country:US
Practice Address - Phone:231-557-2869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501007315225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist