MEDICARE: STACY M PFARR 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	225XP0200X	Pediatric Occupational Therapist	102531	MN

General Provider Information

NPI Number	:	1467300160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY M PFARR OTR/L

Provider Business Mailing Address
First Line	:	15120 PORTLAND AVE
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55306-5005
Country	:	US
Telephone Number	:	612-802-3883
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 RED PINE LN
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55123-2182
Country	:	US
Telephone Number	:	651-423-7870
Fax Number	:

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

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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Directions to “ STACY M PFARR OTR/L” Practice Location

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