Provider Demographics
NPI:1750654877
Name:FIALA, STACIE (OTR/L)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:FIALA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4911 S 149TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1452
Mailing Address - Country:US
Mailing Address - Phone:402-350-6550
Mailing Address - Fax:
Practice Address - Street 1:8214 F ST STE C
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1740
Practice Address - Country:US
Practice Address - Phone:402-509-2555
Practice Address - Fax:402-509-2600
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE785225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist