Provider Demographics
NPI:1467670968
Name:METHENEY, STACY ANN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:ANN
Last Name:METHENEY
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 1:1310 GARY BLVD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-2914
Mailing Address - Country:US
Mailing Address - Phone:216-410-8285
Mailing Address - Fax:330-220-1425
Practice Address - Street 1:1310 GARY BLVD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-2914
Practice Address - Country:US
Practice Address - Phone:216-410-8285
Practice Address - Fax:330-220-1425
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH004434225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist