Provider Demographics
NPI:1437343787
Name:FARRIS, STACEY (OTR/L, MS)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:FARRIS
Suffix:
Gender:F
Credentials:OTR/L, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 FOXFIRE DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-6004
Mailing Address - Country:US
Mailing Address - Phone:334-712-1657
Mailing Address - Fax:334-712-4927
Practice Address - Street 1:256 HONEYSUCKLE RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1157
Practice Address - Country:US
Practice Address - Phone:334-712-1657
Practice Address - Fax:334-712-4927
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2480225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics