MEDICARE: MRS. MARCIA JANE STAMER PT

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	225100000X	Physical Therapist	2837	OH

General Provider Information

NPI Number	:	1982871430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARCIA JANE STAMER PT

Provider Business Mailing Address
First Line	:	2949 MILLBORO RD
Second Line	:
City	:	SILVER LAKE
State	:	OH
Zip	:	44224
Country	:	US
Telephone Number	:	330-923-0696
Fax Number	:	330-723-0696

Provider Business Practice Location Address
First Line	:	2949 MILLBORO RD
Second Line	:
City	:	SILVER LAKE
State	:	OH
Zip	:	44224
Country	:	US
Telephone Number	:	330-923-0696
Fax Number	:	330-723-0696

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

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	05/14/2008

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