Provider Demographics
NPI:1003079559
Name:RYMAN, STACY A (COTA)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:A
Last Name:RYMAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 E CORNELIUS HARNETT BLVD
Mailing Address - Street 2:UNIVERSAL HEALTHCARE
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-8276
Mailing Address - Country:US
Mailing Address - Phone:910-814-0880
Mailing Address - Fax:910-814-0890
Practice Address - Street 1:1995 E CORNELIUS HARNETT BLVD
Practice Address - Street 2:UNIVERSAL HEALTHCARE
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-8276
Practice Address - Country:US
Practice Address - Phone:910-814-0880
Practice Address - Fax:910-814-0890
Is Sole Proprietor?:No
Enumeration Date:2008-07-04
Last Update Date:2011-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY983532224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant