Healthcare Provider Details

I. General information

NPI: 1396054284
Provider Name (Legal Business Name): STACEY OZIAS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N KENTUCKY AVE
WEST PLAINS MO
65775-2028
US

IV. Provider business mailing address

1111 N KENTUCKY AVE P.O. BOX 1100
WEST PLAINS MO
65775-2028
US

V. Phone/Fax

Practice location:
  • Phone: 417-257-5959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number2009032051
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: