Provider Demographics
NPI:1225475379
Name:BUSER, STACEY (PHD AT ATC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:BUSER
Suffix:
Gender:F
Credentials:PHD AT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 HUGHSTOWNE DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-1546
Mailing Address - Country:US
Mailing Address - Phone:330-310-1177
Mailing Address - Fax:
Practice Address - Street 1:600 BEAVERBROOK DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-2820
Practice Address - Country:US
Practice Address - Phone:330-869-6828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer