Provider Demographics
NPI:1154496404
Name:SIZEMORE, STACY MICHELLE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:MICHELLE
Last Name:SIZEMORE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 TOY CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-6031
Mailing Address - Country:US
Mailing Address - Phone:502-955-5086
Mailing Address - Fax:
Practice Address - Street 1:329 TOWNEPARK CIR
Practice Address - Street 2:100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2348
Practice Address - Country:US
Practice Address - Phone:502-254-9524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3019225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKYR3019OtherSTATE LICENSURE