Provider Demographics
NPI:1457524225
Name:DOBEK, STACEY LEE (CMT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LEE
Last Name:DOBEK
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 MILL RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:VT
Mailing Address - Zip Code:05443-9691
Mailing Address - Country:US
Mailing Address - Phone:802-453-2825
Mailing Address - Fax:
Practice Address - Street 1:54 MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1426
Practice Address - Country:US
Practice Address - Phone:802-388-0414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist