Provider Demographics
NPI:1386934479
Name:MAPES, STACEY ANNE (OTRL, CHT,CLT,LMT)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ANNE
Last Name:MAPES
Suffix:
Gender:F
Credentials:OTRL, CHT,CLT,LMT
Other - Prefix:MISS
Other - First Name:STACEY
Other - Middle Name:ANNE
Other - Last Name:RENDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT,CHT, CMT
Mailing Address - Street 1:728 W WACKERLY ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4724
Mailing Address - Country:US
Mailing Address - Phone:989-837-6869
Mailing Address - Fax:989-835-3398
Practice Address - Street 1:728 W WACKERLY ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4724
Practice Address - Country:US
Practice Address - Phone:989-837-6869
Practice Address - Fax:989-835-3398
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005956225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5201005956OtherLICENSE NUMBER