Provider Demographics
NPI:1356671986
Name:CLINE, STACEY (OTR)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:CLINE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 N BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2823
Mailing Address - Country:US
Mailing Address - Phone:732-682-1060
Mailing Address - Fax:
Practice Address - Street 1:336 S 10TH ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4934
Practice Address - Country:US
Practice Address - Phone:970-249-1412
Practice Address - Fax:970-249-0245
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2489225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist