Provider Demographics
NPI:1164810982
Name:GRIESHABER, STCY (OTR/L)
Entity Type:Individual
Prefix:
First Name:STCY
Middle Name:
Last Name:GRIESHABER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 SHORE LINE DR
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-1385
Mailing Address - Country:US
Mailing Address - Phone:502-727-9169
Mailing Address - Fax:
Practice Address - Street 1:1031 SHORE LINE DR
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-1385
Practice Address - Country:US
Practice Address - Phone:502-727-9169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2526225X00000X
IN31003443A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist