Provider Demographics
NPI:1831638527
Name:STONNER, MACYN (OT)
Entity Type:Individual
Prefix:MS
First Name:MACYN
Middle Name:
Last Name:STONNER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-286-1669
Mailing Address - Fax:314-514-3635
Practice Address - Street 1:14532 S OUTER 40 RD
Practice Address - Street 2:DEPT OCCUPATIONAL THERAPY, STE 120
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5705
Practice Address - Country:US
Practice Address - Phone:314-286-1669
Practice Address - Fax:314-514-3635
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017001212225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO470052738Medicaid