Active NPI
Mary Claire Stillman, LMT
- Massage Therapist
- Mequon, WI
National Provider Identifier
1023589835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 14789-146
- Practice address
- 10134 N Port Washington Rd
Mequon, WI 53092-5700 - Phone
- (414) 303-5915
- NPI assigned
- Dec 6, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 14789-146 | WI | Primary |
Addresses
Primary practice location
10134 N Port Washington Rd
Mequon, WI 53092-5700
Mailing address
9109 N Tennyson Dr
Bayside, WI 53217-1970
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14789-146 | Other | WI | DEPARTMENT OF SAFETY & PROFESSIONAL SERVICES |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14789-146 | WI | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1544054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1544054400000",
"number": "1023589835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9109 N TENNYSON DR",
"city": "BAYSIDE",
"state": "WI",
"postal_code": "532171970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10134 N PORT WASHINGTON RD",
"city": "MEQUON",
"state": "WI",
"postal_code": "530925700",
"telephone_number": "414-303-5915"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STILLMAN",
"first_name": "MARY",
"middle_name": "CLAIRE",
"name_prefix": "Ms.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-12-06",
"last_updated": "2018-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WI",
"license": "14789-146",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPARTMENT OF SAFETY & PROFESSIONAL SERVICES",
"identifier": "14789-146",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mequon, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.