Provider Demographics
NPI:1851713820
Name:VRTISKA, STACEY (OTR/L, CLT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:VRTISKA
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2959 US HIGHWAY 275
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:IA
Mailing Address - Zip Code:51640-5052
Mailing Address - Country:US
Mailing Address - Phone:712-382-1515
Mailing Address - Fax:712-382-1503
Practice Address - Street 1:2959 US HIGHWAY 275
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:IA
Practice Address - Zip Code:51640-5052
Practice Address - Country:US
Practice Address - Phone:712-382-1515
Practice Address - Fax:712-382-1503
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1298225X00000X
IA002263225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist