Healthcare Provider Details

I. General information

NPI: 1114486032
Provider Name (Legal Business Name): STACEY BARTLETT MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 RIDGECREST CIR
LEWISBURG PA
17837-6367
US

IV. Provider business mailing address

15 RIDGECREST CIR
LEWISBURG PA
17837-6367
US

V. Phone/Fax

Practice location:
  • Phone: 570-762-1734
  • Fax: 855-232-8604
Mailing address:
  • Phone: 570-762-1734
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC011642
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: