Provider Demographics
NPI:1942758735
Name:HOHMAN, STACY (LMT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:HOHMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:MISTRETTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1560 ENGMAN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SKANDIA
Mailing Address - State:MI
Mailing Address - Zip Code:49885-9429
Mailing Address - Country:US
Mailing Address - Phone:906-346-4179
Mailing Address - Fax:
Practice Address - Street 1:2292 US 41 W
Practice Address - Street 2:SUITE #3
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2483
Practice Address - Country:US
Practice Address - Phone:906-251-0387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501009473225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist