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General NPI Number Information
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NPI Number | 1326782731
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Entity Type | Individual
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Provider Name | STACEY CAROLINE LUNSFORD
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Gender | Female
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Dates
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Enumeration Date | 04/21/2022
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Last Update Date | 04/21/2022
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Provider Practice Location Address
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Address Line | 901 W MAIN ST
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City | YADKINVILLE
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State | NC
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Zip | 27055-7807
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Country | US
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Telephone | 855-983-0488
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Fax |
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Provider Business Mailing Address
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Address Line | 138 RIDGE MEADOW LOOP
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City | STONY POINT
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State | NC
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Zip | 28678-9228
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Country | US
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Telephone | 704-881-3236
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 14859
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License Number State | NC
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