Provider Demographics
NPI:1538118294
Name:SPOHN, STACY LYNN (OTR, CHT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:SPOHN
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:HUIZENGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-0629
Mailing Address - Country:US
Mailing Address - Phone:843-671-7342
Mailing Address - Fax:843-671-7343
Practice Address - Street 1:8 HOSPITAL CENTER BLVD STE 250
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-8702
Practice Address - Country:US
Practice Address - Phone:843-671-7342
Practice Address - Fax:843-671-7343
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004623225XH1200X
SC6442225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand