Provider Demographics
NPI:1396949327
Name:MCCREARY, STACEY LEIGH (LOTA)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:LEIGH
Last Name:MCCREARY
Suffix:
Gender:F
Credentials:LOTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 N BUSINESS 45
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-1491
Mailing Address - Country:US
Mailing Address - Phone:903-654-2172
Mailing Address - Fax:903-872-5833
Practice Address - Street 1:3300 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2412
Practice Address - Country:US
Practice Address - Phone:903-641-0626
Practice Address - Fax:903-641-0626
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208180224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant