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NPI Code Detail

MEDICARE: MS. STACY MARIE CHAUDOIR OTR

MEDICARE: MS. STACY MARIE CHAUDOIR 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
1225X00000XOccupational Therapist2959-026WI

General Provider Information

NPI Number : 1427306117
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. STACY MARIE CHAUDOIR OTR
Provider Business Mailing Address
First Line : 1924 N HUBBARD ST APT 402
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-3792
Country : US
Telephone Number : 414-460-8889
Fax Number :
Provider Business Practice Location Address
First Line : 1825 N PROSPECT AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-1933
Country : US
Telephone Number : 414-298-8451
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2012
Last Update Date : 08/28/2012

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