Provider Demographics
NPI:1578789228
Name:WENTZ, STACY MICHELLE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:MICHELLE
Last Name:WENTZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:STACY
Other - Middle Name:MICHELLE
Other - Last Name:MCCABE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:605 CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-1611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:605 CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-1611
Practice Address - Country:US
Practice Address - Phone:610-967-0430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOCOO8413225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist