Healthcare Provider Details

I. General information

NPI: 1952683344
Provider Name (Legal Business Name): STACEY HOTOPP PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACEY CONNER

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10663 MONTGOMERY RD
CINCINNATI OH
45242-4403
US

IV. Provider business mailing address

10663 MONTGOMERY RD
CINCINNATI OH
45242-4403
US

V. Phone/Fax

Practice location:
  • Phone: 513-794-8465
  • Fax: 513-792-3230
Mailing address:
  • Phone: 513-794-8465
  • Fax: 513-792-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT013401
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: