Provider Demographics
NPI:1356116206
Name:SCHAFSTALL, VANESSA JO
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:JO
Last Name:SCHAFSTALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 GEORGE MAC LN UNIT B
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28164-9716
Mailing Address - Country:US
Mailing Address - Phone:606-793-0298
Mailing Address - Fax:
Practice Address - Street 1:514 GEORGE MAC LN UNIT B
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NC
Practice Address - Zip Code:28164-9716
Practice Address - Country:US
Practice Address - Phone:606-793-0298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16822225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist