Provider Demographics
NPI:1164953758
Name:PIERSON, STACIE SPIKER (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:SPIKER
Last Name:PIERSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:SPIKER
Other - Last Name:PIERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3344 W HALEY DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-3366
Mailing Address - Country:US
Mailing Address - Phone:480-466-9416
Mailing Address - Fax:
Practice Address - Street 1:3344 W HALEY DR
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-3366
Practice Address - Country:US
Practice Address - Phone:480-466-9416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-1701225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist