Provider Demographics
NPI:1376683524
Name:BANKS, STACEY A (ATR)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:A
Last Name:BANKS
Suffix:
Gender:F
Credentials:ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37057 CHADDWYCK LN
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44035-8745
Mailing Address - Country:US
Mailing Address - Phone:440-353-3326
Mailing Address - Fax:
Practice Address - Street 1:6600 E SCHAAF RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-1316
Practice Address - Country:US
Practice Address - Phone:216-524-3787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist