Provider Demographics
NPI:1649587718
Name:NEILL, STACEY ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ANN
Last Name:NEILL
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 1:1766 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1905
Mailing Address - Country:US
Mailing Address - Phone:530-242-1511
Mailing Address - Fax:530-242-1611
Practice Address - Street 1:1766 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1905
Practice Address - Country:US
Practice Address - Phone:530-242-1511
Practice Address - Fax:530-242-1611
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2225225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist