Provider Demographics
NPI:1215329438
Name:WYATT, STACIE (MOT, OTR)
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:
Last Name:WYATT
Suffix:
Gender:F
Credentials:MOT, OTR
Other - Prefix:MS
Other - First Name:STACIE
Other - Middle Name:
Other - Last Name:BARMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR
Mailing Address - Street 1:13150 FM 529 RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-2570
Mailing Address - Country:US
Mailing Address - Phone:713-896-1815
Mailing Address - Fax:713-896-1853
Practice Address - Street 1:13150 FM 529 RD
Practice Address - Street 2:SUITE 114
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-2570
Practice Address - Country:US
Practice Address - Phone:713-896-1815
Practice Address - Fax:713-896-1853
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116209225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics