Provider Demographics
NPI:1417767559
Name:RUTLEDGE, STACY LEA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LEA
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22379 COUNTY ROAD I50
Mailing Address - Street 2:
Mailing Address - City:WEST UNITY
Mailing Address - State:OH
Mailing Address - Zip Code:43570-9755
Mailing Address - Country:US
Mailing Address - Phone:419-682-7568
Mailing Address - Fax:
Practice Address - Street 1:205 NOLAN PKWY
Practice Address - Street 2:
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502-8404
Practice Address - Country:US
Practice Address - Phone:567-444-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT005240225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist