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NPI Code Detail

MEDICARE: STACIE MCNETT OTR

MEDICARE: STACIE MCNETT OTR
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
1224Z00000XOccupational Therapy Assistant007181NY
2225X00000XOccupational Therapist024001NY

General Provider Information

NPI Number : 1194020768
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACIE MCNETT OTR
Provider Business Mailing Address
First Line : 234 OAKRIDGE AVE
Second Line :
City : TONAWANDA
State : NY
Zip : 14217-1165
Country : US
Telephone Number : 716-909-8910
Fax Number :
Provider Business Practice Location Address
First Line : 5205 OAKWOOD DR
Second Line :
City : NORTH TONAWANDA
State : NY
Zip : 14120-9618
Country : US
Telephone Number : 716-625-4002
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2011
Last Update Date : 09/20/2019

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