Provider Demographics
NPI:1124625454
Name:STOUT, CASEY LEE (OT)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:LEE
Last Name:STOUT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4538 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1364
Mailing Address - Country:US
Mailing Address - Phone:181-486-4665
Mailing Address - Fax:
Practice Address - Street 1:212 IRIS RD
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-2402
Practice Address - Country:US
Practice Address - Phone:412-741-2375
Practice Address - Fax:724-647-1570
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015335225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist