Provider Demographics
NPI:1942447727
Name:BRAZIE, STACEY LYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYN
Last Name:BRAZIE
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 1:9939 PARKLAND DR
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-3317
Mailing Address - Country:US
Mailing Address - Phone:330-425-7371
Mailing Address - Fax:
Practice Address - Street 1:9939 PARKLAND DR
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-3317
Practice Address - Country:US
Practice Address - Phone:330-425-7371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04276225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist