Provider Demographics
NPI:1972026680
Name:BEYER, STACEY LESNICK (OTR)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LESNICK
Last Name:BEYER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LESNICK
Other - Last Name:BEYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:1810 CHARTWELL DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49696-9283
Mailing Address - Country:US
Mailing Address - Phone:231-929-2354
Mailing Address - Fax:231-929-2853
Practice Address - Street 1:1810 CHARTWELL DR.
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49696
Practice Address - Country:US
Practice Address - Phone:231-929-2354
Practice Address - Fax:231-929-2853
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004472225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics