Provider Demographics
NPI:1932463718
Name:PARUCH, STACY ANN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:ANN
Last Name:PARUCH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 MERRITT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6916
Mailing Address - Country:US
Mailing Address - Phone:517-332-3232
Mailing Address - Fax:517-332-1132
Practice Address - Street 1:2111 MERRITT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6916
Practice Address - Country:US
Practice Address - Phone:517-332-3232
Practice Address - Fax:517-332-1132
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007713225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist