Provider Demographics
NPI:1952396483
Name:DUBOIS, STACY L (MOT)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:L
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:MS
Other - First Name:STACY
Other - Middle Name:L
Other - Last Name:MEANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT
Mailing Address - Street 1:5930 6TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-1115
Mailing Address - Country:US
Mailing Address - Phone:814-515-1049
Mailing Address - Fax:814-515-1050
Practice Address - Street 1:5930 6TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-1115
Practice Address - Country:US
Practice Address - Phone:814-515-1049
Practice Address - Fax:814-515-1050
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005573L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA670001673OtherRR MEDICARE
PA1398618OtherHIGHMARK
PA670001673OtherRR MEDICARE
PA1398618OtherHIGHMARK