Provider Demographics
NPI:1548401912
Name:BROWN, STACEY HARRIS (MHS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:HARRIS
Last Name:BROWN
Suffix:
Gender:F
Credentials:MHS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 BENJAMIN REID CT
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-9156
Mailing Address - Country:US
Mailing Address - Phone:864-237-4061
Mailing Address - Fax:
Practice Address - Street 1:414 BENJAMIN REID CT
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-9156
Practice Address - Country:US
Practice Address - Phone:864-237-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2711225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist