Provider Demographics
NPI:1285750935
Name:LEVINE, STACI L (COTA)
Entity type:Individual
Prefix:MISS
First Name:STACI
Middle Name:L
Last Name:LEVINE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:STACI
Other - Middle Name:L
Other - Last Name:KERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1228 S FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103
Mailing Address - Country:US
Mailing Address - Phone:484-221-9729
Mailing Address - Fax:
Practice Address - Street 1:3250 STATE STREET
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960
Practice Address - Country:US
Practice Address - Phone:215-257-2751
Practice Address - Fax:215-257-4128
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOPOO1208L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant