Provider Demographics
NPI:1326812751
Name:HEYMAN, STACY JACOBSON (OT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:JACOBSON
Last Name:HEYMAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:LEIGH
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1104 BAILIFF CT NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2665
Mailing Address - Country:US
Mailing Address - Phone:404-409-6125
Mailing Address - Fax:
Practice Address - Street 1:1104 BAILIFF CT NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-2665
Practice Address - Country:US
Practice Address - Phone:404-409-6125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT0003579225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics