Provider Demographics
NPI:1063125888
Name:PAPER, STACY LAWRENCE (ATC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LAWRENCE
Last Name:PAPER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710A ROCKLEDGE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2843
Mailing Address - Country:US
Mailing Address - Phone:301-538-0521
Mailing Address - Fax:240-912-2382
Practice Address - Street 1:6710A ROCKLEDGE DR STE 130
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-2843
Practice Address - Country:US
Practice Address - Phone:301-515-0900
Practice Address - Fax:240-912-2382
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00008822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer