Wilson, Stacey A

Wilson, Stacey A is an individual health care provider with primary practice located at 2605 E Creeks Edge Dr , Bloomington IN 47401-8368. She recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Hand, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist is her primary health care specialty. Wilson, Stacey A can be contacted via phone (812) 333-2663.

Contact Information

Primary practice address
2605 E Creeks Edge Dr Bloomington IN 47401-8368
Phone: (812) 333-2663
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Hand 225XH1200X 31004123A Indiana
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist 225X00000X 31004123A Indiana

Profile Details

NPI number 1932890803
LBN Legal business name Wilson, Stacey A
Credentials Occupational Therapist (OT)
Entity Individual
Sole proprietor 1 No
Enumeration date May 19th, 2023
Last updated Oct 18th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932890803 NPPES
Indiana Other 090540881 MEDICARE PTAN
Indiana MEDICAID 300081337 MEDICARE PTAN

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