Provider Demographics
NPI:1306220967
Name:RIGGS, STACI (COTA/L)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:RIGGS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 ALABAMA AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH LAWRENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44666-9491
Mailing Address - Country:US
Mailing Address - Phone:330-495-4989
Mailing Address - Fax:
Practice Address - Street 1:1167 ALABAMA AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH LAWRENCE
Practice Address - State:OH
Practice Address - Zip Code:44666-9491
Practice Address - Country:US
Practice Address - Phone:330-495-4989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.04625224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant