Provider Demographics
NPI:1184900250
Name:OGDEN, STACY LYNN (ATC)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:LYNN
Last Name:OGDEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2574
Mailing Address - Country:US
Mailing Address - Phone:412-397-4981
Mailing Address - Fax:412-397-4992
Practice Address - Street 1:6001 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-2574
Practice Address - Country:US
Practice Address - Phone:412-397-4981
Practice Address - Fax:412-397-4992
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0045232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer