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General NPI Number Information
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NPI Number | 1336866623
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Entity Type | Individual
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Provider Name | STACEY NELSON MS, OT
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Gender | Female
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Dates
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Enumeration Date | 10/26/2022
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 1573 WILSON RD
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City | RAMONA
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State | CA
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Zip | 92065
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Country | US
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Telephone | 619-322-0744
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Fax |
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Provider Business Mailing Address
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Address Line | 1441 MAIN ST # 272
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City | RAMONA
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State | CA
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Zip | 92065-2128
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Country | US
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Telephone | 619-322-0744
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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 | 5266
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License Number State | CA
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