Provider Demographics
NPI:1700241627
Name:OHL, STACEY (HIS)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:OHL
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 WURZBACH RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240
Mailing Address - Country:US
Mailing Address - Phone:210-593-9500
Mailing Address - Fax:210-593-9504
Practice Address - Street 1:12413 JUDSON RD STE 200
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3215
Practice Address - Country:US
Practice Address - Phone:210-653-1722
Practice Address - Fax:210-653-1742
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80667237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist