Provider Demographics
NPI:1508580929
Name:STAFFORD, KAYCE (OTA)
Entity Type:Individual
Prefix:
First Name:KAYCE
Middle Name:
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:110 DEMOSS CREEK ACCESS RD
Mailing Address - Street 2:
Mailing Address - City:ATWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:38220-4627
Mailing Address - Country:US
Mailing Address - Phone:731-415-3543
Mailing Address - Fax:
Practice Address - Street 1:34 GARLAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3654
Practice Address - Country:US
Practice Address - Phone:731-664-3670
Practice Address - Fax:731-664-2941
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3878224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant