Individual
TAMYKA STOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1769 JASEN AVE APT 2, VALLEY STREAM, NY 11580-2430
(646) 946-5912
Mailing address
1769 JASEN AVE APT 2, VALLEY STREAM, NY 11580-2430
(646) 946-5912
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
018749-01
NY
Other
Enumeration date
03/09/2021
Last updated
03/09/2021
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