Provider Demographics
NPI:1962671917
Name:ST. GEORGE, STACY GAY (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:GAY
Last Name:ST. GEORGE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7227 LAND O LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-2826
Mailing Address - Country:US
Mailing Address - Phone:727-774-2602
Mailing Address - Fax:
Practice Address - Street 1:7227 LAND O LAKES BOULEVARD
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-2826
Practice Address - Country:US
Practice Address - Phone:727-774-2602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 4817224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant