Provider Demographics
NPI:1598297707
Name:SCHAEFFER, STACIA JOHNSON (OTR)
Entity type:Individual
Prefix:
First Name:STACIA
Middle Name:JOHNSON
Last Name:SCHAEFFER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2076
Mailing Address - Country:US
Mailing Address - Phone:614-554-1780
Mailing Address - Fax:
Practice Address - Street 1:839 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2076
Practice Address - Country:US
Practice Address - Phone:614-554-1780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist