Provider Demographics
NPI:1003977497
Name:SANDERS, STACEY RENEE (MS OTRL)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:RENEE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:RENEE
Other - Last Name:COWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2421 GA HIGHWAY 313
Mailing Address - Street 2:
Mailing Address - City:SYLVESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31791-7434
Mailing Address - Country:US
Mailing Address - Phone:229-777-9539
Mailing Address - Fax:
Practice Address - Street 1:2000 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1528
Practice Address - Country:US
Practice Address - Phone:229-434-2580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004223225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist