Provider Demographics
NPI:1922663723
Name:STACEY BEYER, OTR PLLC
Entity Type:Organization
Organization Name:STACEY BEYER, OTR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:LESNICK
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-460-4360
Mailing Address - Street 1:4764 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-7479
Mailing Address - Country:US
Mailing Address - Phone:616-460-4360
Mailing Address - Fax:
Practice Address - Street 1:4764 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-7479
Practice Address - Country:US
Practice Address - Phone:616-460-4360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty