Provider Demographics
NPI:1922359389
Name:LIVERS, STACY MICHELLE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MICHELLE
Last Name:LIVERS
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 1:3020 HIGHWAY 376
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:KY
Mailing Address - Zip Code:40176-7463
Mailing Address - Country:US
Mailing Address - Phone:270-496-4670
Mailing Address - Fax:
Practice Address - Street 1:315 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-1751
Practice Address - Country:US
Practice Address - Phone:812-738-2190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004864A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist