Provider Demographics
NPI:1770368912
Name:KOBE, STACY KAY (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:KAY
Last Name:KOBE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:KAY
Other - Last Name:WASHBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1818 PETUNIA DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7714
Mailing Address - Country:US
Mailing Address - Phone:843-250-1039
Mailing Address - Fax:
Practice Address - Street 1:9224 ARDREY KELL RD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4952
Practice Address - Country:US
Practice Address - Phone:704-316-1495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16244225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist