Provider Demographics
NPI:1518344324
Name:BROWN, STACY RENEE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:RENEE
Last Name:BROWN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:RENEE
Other - Last Name:WULFKUHLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:234 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:GARNETT
Mailing Address - State:KS
Mailing Address - Zip Code:66032-1216
Mailing Address - Country:US
Mailing Address - Phone:785-204-2555
Mailing Address - Fax:913-755-9854
Practice Address - Street 1:234 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:KS
Practice Address - Zip Code:66032-1216
Practice Address - Country:US
Practice Address - Phone:785-204-2555
Practice Address - Fax:913-755-3854
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00835224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant