Provider Demographics
NPI:1922316199
Name:OCASIO, STACI E (IDMT)
Entity Type:Individual
Prefix:MRS
First Name:STACI
Middle Name:E
Last Name:OCASIO
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 FUMI CIR
Mailing Address - Street 2:
Mailing Address - City:KETTLE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99141-8623
Mailing Address - Country:US
Mailing Address - Phone:520-269-3446
Mailing Address - Fax:
Practice Address - Street 1:1191 FUMI CIR
Practice Address - Street 2:
Practice Address - City:KETTLE FALLS
Practice Address - State:WA
Practice Address - Zip Code:99141-8623
Practice Address - Country:US
Practice Address - Phone:520-269-3446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians