Stacy Marrie Lake

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

7501002200 Issued in MI

Practice address

1018 Ludington St
Escanaba, MI 49829-3541

Phone

(702) 277-1369

NPI assigned

Jan 15, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579046400000",
    "number": "1801436027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 S 30TH ST TRLR 80",
            "city": "ESCANABA",
            "state": "MI",
            "postal_code": "498291073",
            "telephone_number": "702-277-1369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1018 LUDINGTON ST",
            "city": "ESCANABA",
            "state": "MI",
            "postal_code": "498293541",
            "telephone_number": "702-277-1369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "STACY",
        "middle_name": "MARRIE",
        "name_prefix": "Miss",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-15",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MI",
            "license": "7501002200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roger W Kulas, MD
• Scott Edward Kwarciany, D.C.
• Justin J Lacrosse, DO
• Tonya Lafave, R.D.
• Tori Ann Lafleur, MD
• Lakeshore Chiropractic Center, P.C.
• Lakeshore Eye Clinic PC
• Lakestate Industries
• Shayne R Lamarch, RD
• Meghan Lamarche

• Massage Therapist in Escanaba, MI
• Providers in Escanaba, MI by specialty
• Massage Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.