Provider Demographics
NPI:1417973934
Name:BAGLEY, STACIE ANN (OTR L)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:ANN
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4333
Mailing Address - Country:US
Mailing Address - Phone:401-767-4600
Mailing Address - Fax:
Practice Address - Street 1:108 HIGH ST
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4333
Practice Address - Country:US
Practice Address - Phone:401-767-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT00592225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI412296OtherEI BCHIP
RI2092OtherEI NHPRC
RI6400144OtherEI UHP
RI292177OtherEI BLUE CROSS
RI407389OtherBLUE CHIP