MEDICARE: STACEY BEYER, OTR PLLC

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

General Provider Information

NPI Number	:	1922663723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STACEY BEYER, OTR PLLC

Provider Business Mailing Address
First Line	:	4764 FAIRWAY DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49685-7479
Country	:	US
Telephone Number	:	616-460-4360
Fax Number	:

Provider Business Practice Location Address
First Line	:	4764 FAIRWAY DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49685-7479
Country	:	US
Telephone Number	:	616-460-4360
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	STACEY LESNICK BEYER
Credential	:
Telephone Number	:	616-460-4360

Provider Enumeration Date	:	05/07/2019
Last Update Date	:	05/07/2019

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