Provider Demographics
NPI:1134493737
Name:STASI'S LOW VISION THERAPY, LLC
Entity Type:Organization
Organization Name:STASI'S LOW VISION THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STASI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GORMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:843-345-2769
Mailing Address - Street 1:602 HIDDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8129
Mailing Address - Country:US
Mailing Address - Phone:843-345-2769
Mailing Address - Fax:
Practice Address - Street 1:602 HIDDEN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8129
Practice Address - Country:US
Practice Address - Phone:843-345-2769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2491225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow VisionGroup - Single Specialty