Provider Demographics
NPI:1982699989
Name:HUMES, STACEY L (OTR L)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:L
Last Name:HUMES
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:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-0023
Mailing Address - Country:US
Mailing Address - Phone:717-877-8811
Mailing Address - Fax:717-732-0178
Practice Address - Street 1:99 NOVEMBER DR
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-5064
Practice Address - Country:US
Practice Address - Phone:717-877-8811
Practice Address - Fax:717-732-0178
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0C002500L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3571011OtherAETNA HMO
PA7600575OtherAETNA PPO
PA76210OtherHEALTH AMERICA COVENTRY H
PA50012506OtherCAPITAL BLUE CROSS