MEDICARE: STACEY KRBEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	5201007451	MI

General Provider Information

NPI Number	:	1164924312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY KRBEZ

Provider Business Mailing Address
First Line	:	4732 E MEADOWS DR SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-6295
Country	:	US
Telephone Number	:	616-308-9635
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 LAKE MICHIGAN DR NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-8042
Country	:	US
Telephone Number	:	616-259-0408
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2018
Last Update Date	:	03/04/2018

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Directions to “ STACEY KRBEZ ” Practice Location

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