Healthcare Provider Details

I. General information

NPI: 1275070609
Provider Name (Legal Business Name): STACEY A HARCUM OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACEY A SCHILLING OTR/L

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 KERNAN DR
GWYNN OAK MD
21207-6665
US

IV. Provider business mailing address

1576 DELLSWAY RD
TOWSON MD
21286-5901
US

V. Phone/Fax

Practice location:
  • Phone: 410-448-2500
  • Fax:
Mailing address:
  • Phone: 571-276-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number06748
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number06748
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: