Provider Demographics
NPI:1861070682
Name:SELLERS, STEFANI (LMT, BCTMB, MMP)
Entity type:Individual
Prefix:
First Name:STEFANI
Middle Name:
Last Name:SELLERS
Suffix:
Gender:F
Credentials:LMT, BCTMB, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PEPPERELL SQ STE 203B
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-3393
Mailing Address - Country:US
Mailing Address - Phone:719-649-2916
Mailing Address - Fax:
Practice Address - Street 1:10 PEPPERELL SQ STE 203B
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3393
Practice Address - Country:US
Practice Address - Phone:207-494-5118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16636225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
844546147OtherIRS