Individual
MS. MARY CLAIRE STILLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
10134 N PORT WASHINGTON RD, MEQUON, WI 53092-5700
(414) 303-5915
Mailing address
9109 N TENNYSON DR, BAYSIDE, WI 53217-1970
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
14789-146
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14789-146
DEPARTMENT OF SAFETY & PROFESSIONAL SERVICES
WI
Enumeration date
12/06/2018
Last updated
12/06/2018
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