Provider Demographics
NPI:1265917744
Name:STAMM, DANIELLE ASHLEY (LMT, MMP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ASHLEY
Last Name:STAMM
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:ASHLEY
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, MMP
Mailing Address - Street 1:22180 PONTIAC TRAIL
Mailing Address - Street 2:SUITE E
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9097
Mailing Address - Country:US
Mailing Address - Phone:248-446-0155
Mailing Address - Fax:248-446-0177
Practice Address - Street 1:22180 PONTIAC TRAIL
Practice Address - Street 2:SUITE E
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-9097
Practice Address - Country:US
Practice Address - Phone:248-446-0155
Practice Address - Fax:248-446-0177
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501010896225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7501010896OtherMASSAGE THERAPIST LICENSE