MEDICARE: STACEY STARR

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	1886	NE

General Provider Information

NPI Number	:	1497132732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY STARR

Provider Business Mailing Address
First Line	:	3320 CALIFORNIA ST
Second Line	:	APT 3
City	:	OMAHA
State	:	NE
Zip	:	68131-1954
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3320 CALIFORNIA ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68131-1954
Country	:	US
Telephone Number	:	800-330-7711
Fax Number	:

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

Provider Enumeration Date	:	05/06/2015
Last Update Date	:	05/06/2015

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Directions to “ STACEY STARR ” Practice Location

Language	Start Address	Practice Location

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