Provider Demographics
NPI:1922730126
Name:SUAREZ, STACY JOANA
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:JOANA
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 MAPLE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6596
Mailing Address - Country:US
Mailing Address - Phone:214-351-6600
Mailing Address - Fax:214-351-5046
Practice Address - Street 1:5701 MAPLE AVE STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6596
Practice Address - Country:US
Practice Address - Phone:214-351-6600
Practice Address - Fax:214-351-5046
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216312224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant