Provider Demographics
NPI:1740686716
Name:BAYNHAM, STACEY (ATC SCAT)
Entity type:Individual
Prefix:MISS
First Name:STACEY
Middle Name:
Last Name:BAYNHAM
Suffix:
Gender:F
Credentials:ATC SCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SPILLWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-3418
Mailing Address - Country:US
Mailing Address - Phone:843-446-1954
Mailing Address - Fax:
Practice Address - Street 1:320 CORLEY MILL RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-8403
Practice Address - Country:US
Practice Address - Phone:803-821-0848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer