Provider Demographics
NPI:1215227814
Name:MAYO, STACYE (OT)
Entity Type:Individual
Prefix:MS
First Name:STACYE
Middle Name:
Last Name:MAYO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9605 LOG RUN CT
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4962
Mailing Address - Country:US
Mailing Address - Phone:817-688-8817
Mailing Address - Fax:
Practice Address - Street 1:4700 ALLIANCE BLVD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5323
Practice Address - Country:US
Practice Address - Phone:469-814-2558
Practice Address - Fax:469-814-2555
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106984225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist