Healthcare Provider Details

I. General information

NPI: 1376683524
Provider Name (Legal Business Name): STACEY A BANKS ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 E SCHAAF RD
INDEPENDENCE OH
44131-1316
US

IV. Provider business mailing address

37057 CHADDWYCK LN
NORTH RIDGEVILLE OH
44035-8745
US

V. Phone/Fax

Practice location:
  • Phone: 216-524-3787
  • Fax:
Mailing address:
  • Phone: 440-353-3326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: