Healthcare Provider Details

I. General information

NPI: 1053992453
Provider Name (Legal Business Name): STACY ROWICKI OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY SEIBERT OTR

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PARK PLACE BLVD
KISSIMMEE FL
34741-2345
US

IV. Provider business mailing address

722 CAVAN DR
APOPKA FL
32703-8339
US

V. Phone/Fax

Practice location:
  • Phone: 407-530-5063
  • Fax: 877-399-5570
Mailing address:
  • Phone: 412-607-3780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT13251
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: