Provider Demographics
NPI:1144359738
Name:GUTZMER, STACY ANN (MOT, OTRL)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:ANN
Last Name:GUTZMER
Suffix:
Gender:F
Credentials:MOT, OTRL
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:ANN
Other - Last Name:COUDRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 COUNTRY OAKS LN
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9620
Mailing Address - Country:US
Mailing Address - Phone:847-366-4789
Mailing Address - Fax:
Practice Address - Street 1:9 COUNTRY OAKS LN
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9620
Practice Address - Country:US
Practice Address - Phone:847-366-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics