Provider Demographics
NPI:1881645604
Name:MCGLORY, STACY ELIZABETH (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ELIZABETH
Last Name:MCGLORY
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:ELIZABETH
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/ L , CHT
Mailing Address - Street 1:800 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-7241
Mailing Address - Country:US
Mailing Address - Phone:405-609-3667
Mailing Address - Fax:800-506-3795
Practice Address - Street 1:4645 W GORE BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6041
Practice Address - Country:US
Practice Address - Phone:580-355-6785
Practice Address - Fax:580-355-6788
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1031100248225XH1200X
OKOT405225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
245602602Medicare ID - Type Unspecified