Provider Demographics
NPI:1851932982
Name:WHITFIELD, STACIE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 N NC 241 HWY
Mailing Address - Street 2:
Mailing Address - City:BEULAVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28518-8636
Mailing Address - Country:US
Mailing Address - Phone:910-298-2331
Mailing Address - Fax:910-375-3031
Practice Address - Street 1:160 N NC 241 HWY
Practice Address - Street 2:
Practice Address - City:BEULAVILLE
Practice Address - State:NC
Practice Address - Zip Code:28518-8636
Practice Address - Country:US
Practice Address - Phone:910-298-2331
Practice Address - Fax:910-375-3031
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12880225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist