Provider Demographics
NPI:1063000917
Name:NIEMIEC, STACEY LYNN SCHEPENS (OTR/L)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:LYNN SCHEPENS
Last Name:NIEMIEC
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LYNN
Other - Last Name:SCHEPENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1540 ALCAZAR ST # ST-133
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-0186
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1540 ALCAZAR ST # ST-133
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0186
Practice Address - Country:US
Practice Address - Phone:323-442-2069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
13625225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist