Provider Demographics
NPI:1396611737
Name:SUMMERS, STACEY M (MAAT, ATR)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:M
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:MAAT, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6630 EMBASSY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-4898
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6630 EMBASSY BLVD STE B
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4898
Practice Address - Country:US
Practice Address - Phone:813-997-6103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-14
Last Update Date:2025-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No171W00000XOther Service ProvidersContractor