MEDICARE: MRS. STACEY L HUMES OTR L

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	225XH1200X	Hand Occupational Therapist	7472	SC
2	225XH1200X	Hand Occupational Therapist
3	225X00000X	Occupational Therapist	OC002500L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3571011	OTHER	PA	AETNA HMO
2	50012506	OTHER	PA	CAPITAL BLUE CROSS
3	7600575	OTHER	PA	AETNA PPO
4	76210	OTHER	PA	HEALTH AMERICA COVENTRY H

General Provider Information

NPI Number	:	1982699989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACEY L HUMES OTR L

Provider Business Mailing Address
First Line	:	PO BOX 23
Second Line	:
City	:	ENOLA
State	:	PA
Zip	:	17025-0023
Country	:	US
Telephone Number	:	717-877-8811
Fax Number	:	717-732-0178

Provider Business Practice Location Address
First Line	:	850 WALNUT BOTTOM RD STE 306
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17013-3615
Country	:	US
Telephone Number	:	717-877-8811
Fax Number	:	717-918-5745

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	03/06/2025

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