Provider Demographics
NPI:1699073759
Name:MCCLEAF, STACY LYNN
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LYNN
Last Name:MCCLEAF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6596 ORPHANAGE RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:PA
Practice Address - Zip Code:17247
Practice Address - Country:US
Practice Address - Phone:717-749-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007016224Z00000X
MDA01828224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant