Provider Demographics
NPI:1578074803
Name:STASIK, BRITTANY (OTR)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:STASIK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33359 CHELSEA AVE
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1224
Mailing Address - Country:US
Mailing Address - Phone:1440-654-8349
Mailing Address - Fax:
Practice Address - Street 1:10190 FAIRMOUNT RD
Practice Address - Street 2:
Practice Address - City:NEWBURY
Practice Address - State:OH
Practice Address - Zip Code:44065-9531
Practice Address - Country:US
Practice Address - Phone:440-564-9101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$Medicaid