Provider Demographics
NPI:1114642246
Name:LIFSEY, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:LIFSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5702 GREEN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-2330
Mailing Address - Country:US
Mailing Address - Phone:281-543-4519
Mailing Address - Fax:
Practice Address - Street 1:2929 POST OAK BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-6120
Practice Address - Country:US
Practice Address - Phone:713-993-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant