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NPI Code Detail

MEDICARE: STACEY TRENT OTR/L

MEDICARE:   STACEY  TRENT  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
1225X00000XOccupational Therapist4407TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568750909
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY TRENT OTR/L
Provider Business Mailing Address
First Line : 6161 BURGESS FALLS RD
Second Line :
City : SPARTA
State : TN
Zip : 38583-5158
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11396 PETE CARR RIDGE RD
Second Line :
City : SILVER POINT
State : TN
Zip : 38582
Country : US
Telephone Number : 615-489-3151
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2011
Last Update Date : 08/21/2018

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Directions to “ STACEY TRENT OTR/L” Practice Location

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