Provider Demographics
NPI:1396057378
Name:ANGEL, LACIE MARIE (CNMT)
Entity type:Individual
Prefix:MS
First Name:LACIE
Middle Name:MARIE
Last Name:ANGEL
Suffix:
Gender:F
Credentials:CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11076
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59904-4076
Mailing Address - Country:US
Mailing Address - Phone:406-253-8016
Mailing Address - Fax:406-257-5116
Practice Address - Street 1:40 SECOND STREET EAST
Practice Address - Street 2:SUITE 235
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-253-8016
Practice Address - Fax:406-257-5116
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist