MEDICARE: STACY DEES 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
1	225X00000X	Occupational Therapist	102805	TX

General Provider Information

NPI Number	:	1598246258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY DEES OTR

Provider Business Mailing Address
First Line	:	1700 PROVIDENCE DR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76707-2260
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 PROVIDENCE DR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76707-2260
Country	:	US
Telephone Number	:	254-761-8500
Fax Number	:

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

Provider Enumeration Date	:	08/21/2018
Last Update Date	:	08/21/2018

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Directions to “ STACY DEES OTR” Practice Location

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