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General NPI Number Information
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NPI Number | 1396949327
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Entity Type | Individual
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Provider Name | STACEY LEIGH MCCREARY LOTA
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Gender | Female
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3300 W 2ND AVE
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City | CORSICANA
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State | TX
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Zip | 75110-2412
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Country | US
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Telephone | 903-641-0626
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Fax | 903-641-0626
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Provider Business Mailing Address
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Address Line | 3290 N BUSINESS 45
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City | CORSICANA
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State | TX
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Zip | 75110-1491
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Country | US
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Telephone | 903-654-2172
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Fax | 903-872-5833
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 208180
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License Number State | TX
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