Provider Demographics
NPI:1518382399
Name:STUCKY, KEILA (COTA/L)
Entity Type:Individual
Prefix:
First Name:KEILA
Middle Name:
Last Name:STUCKY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 KENSINGTON LN
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-3109
Mailing Address - Country:US
Mailing Address - Phone:419-953-2826
Mailing Address - Fax:
Practice Address - Street 1:904 KENSINGTON LN
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-3109
Practice Address - Country:US
Practice Address - Phone:419-953-2826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.02592224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant