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General NPI Number Information
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NPI Number | 1699197194
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Entity Type | Individual
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Provider Name | STACEY REIKO LEONG MINSON DOT
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Gender | Female
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Dates
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Enumeration Date | 01/17/2014
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 9802 48TH DR NE
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City | MARYSVILLE
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State | WA
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Zip | 98270-8100
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Country | US
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Telephone | 808-232-8263
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Fax |
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Provider Business Mailing Address
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Address Line | 1809 NE 172ND ST
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City | SHORELINE
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State | WA
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Zip | 98155-6034
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT60441895
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License Number State | WA
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