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General NPI Number Information
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NPI Number | 1497974919
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Entity Type | Individual
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Provider Name | STACEY MAKOSKY
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8380 NC HIGHWAY 87
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City | REIDSVILLE
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State | NC
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Zip | 27320-8898
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Country | US
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Telephone | 336-616-1955
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Fax |
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Provider Business Mailing Address
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Address Line | 1122 IVANHOE RD
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City | MOUNT VERNON
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State | IA
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Zip | 52314-9667
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Country | US
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Telephone |
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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 | 6436
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License Number State | NC
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