Provider Demographics
NPI:1366251886
Name:HARRIS, STACY RENEE
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:RENEE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:RENEE
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:RATLIFF CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73481-0337
Mailing Address - Country:US
Mailing Address - Phone:361-816-8610
Mailing Address - Fax:
Practice Address - Street 1:2150 W ELK AVE
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1827
Practice Address - Country:US
Practice Address - Phone:580-251-8460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2664224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant