Provider Demographics
NPI:1942456546
Name:GOLDSTEIN, STACY ANN (OTR/L, CHT, CLT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:OTR/L, CHT, CLT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:ANN
Other - Last Name:SCHMIDL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, CHT, CLT
Mailing Address - Street 1:911 HOLY CROSS RD
Mailing Address - Street 2:
Mailing Address - City:STREET
Mailing Address - State:MD
Mailing Address - Zip Code:21154-1119
Mailing Address - Country:US
Mailing Address - Phone:443-223-9902
Mailing Address - Fax:
Practice Address - Street 1:12 MEDSTAR BLVD STE 325
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-1817
Practice Address - Country:US
Practice Address - Phone:410-877-8078
Practice Address - Fax:410-877-8079
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC013868225X00000X
MD04600225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist