MEDICARE: STACEY LYNN HAUSER MA, ATR

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	221700000X	Art Therapist

General Provider Information

NPI Number	:	1285843052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY LYNN HAUSER MA, ATR

Provider Business Mailing Address
First Line	:	179 ELDON DR NW
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-1341
Country	:	US
Telephone Number	:	330-647-8535
Fax Number	:

Provider Business Practice Location Address
First Line	:	4877 GALAXY PKWY STE A
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-5952
Country	:	US
Telephone Number	:	216-378-5050
Fax Number	:	216-378-5060

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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