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NPI Code Detail

MEDICARE: MRS. STACI LYN FOUKE MS, OTR

MEDICARE:  MRS. STACI LYN FOUKE  MS, 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 Therapist114005TX

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 : 1881963551
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STACI LYN FOUKE MS, OTR
Provider Business Mailing Address
First Line : 250 SANTA FE DR
Second Line :
City : WEATHERFORD
State : TX
Zip : 76086-6585
Country : US
Telephone Number : 817-550-5058
Fax Number :
Provider Business Practice Location Address
First Line : 250 SANTA FE DR
Second Line :
City : WEATHERFORD
State : TX
Zip : 76086-6585
Country : US
Telephone Number : 817-550-5058
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2011
Last Update Date : 03/20/2018

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