Provider Demographics
NPI:1568432458
Name:HUFFMAN, STACEY DIANE (OTR/L)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:DIANE
Last Name:HUFFMAN
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 1:312 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-1888
Mailing Address - Country:US
Mailing Address - Phone:641-844-2294
Mailing Address - Fax:641-844-2297
Practice Address - Street 1:312 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-1888
Practice Address - Country:US
Practice Address - Phone:641-844-2294
Practice Address - Fax:641-844-2297
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00895225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA38038OtherBLUE CROSS BLUE SHIELD
I14931Medicare ID - Type Unspecified