Provider Demographics
NPI:1518366780
Name:CHAMBERS, STACEY (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:CHAMBERS
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 1:8116 HARTHAM PARK AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5990
Mailing Address - Country:US
Mailing Address - Phone:919-295-4083
Mailing Address - Fax:
Practice Address - Street 1:2701 PICKETT RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-5688
Practice Address - Country:US
Practice Address - Phone:919-419-9600
Practice Address - Fax:919-489-2296
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7445225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist