Healthcare Provider Details

I. General information

NPI: 1629546155
Provider Name (Legal Business Name): STACEY SEAVEY MS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10990 BELTON HONEA PATH HWY
HONEA PATH SC
29654-9506
US

IV. Provider business mailing address

515 ESKEW CIR
ANDERSON SC
29621-4272
US

V. Phone/Fax

Practice location:
  • Phone: 864-369-7364
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5184
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: