MEDICARE: MRS. STACY LEA BORGIO OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	6208	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6208	OTHER	OH	OCCUPATIONAL THERAPIST

General Provider Information

NPI Number	:	1033369350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACY LEA BORGIO OTR/L

Provider Business Mailing Address
First Line	:	928 W MARKET ST
Second Line	:
City	:	TIFFIN
State	:	OH
Zip	:	44883-2529
Country	:	US
Telephone Number	:	419-447-2927
Fax Number	:

Provider Business Practice Location Address
First Line	:	928 W MARKET ST
Second Line	:
City	:	TIFFIN
State	:	OH
Zip	:	44883-2529
Country	:	US
Telephone Number	:	419-447-2927
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	12/12/2024

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