Provider Demographics
NPI:1831392281
Name:YAGOW, STACY M (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:M
Last Name:YAGOW
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 RAASCH DRIVE
Mailing Address - Street 2:SPIER PHYSICAL THERAPY
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3455
Mailing Address - Country:US
Mailing Address - Phone:402-371-2722
Mailing Address - Fax:402-371-3313
Practice Address - Street 1:3200 RAASCH DRIVE
Practice Address - Street 2:SPIER PHYSICAL THERAPY
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3455
Practice Address - Country:US
Practice Address - Phone:402-371-2722
Practice Address - Fax:402-371-3313
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1518225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist