Provider Demographics
NPI:1982699989
Name:HUMES, STACEY L (OTR L)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:L
Last Name:HUMES
Suffix:
Gender:
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:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-0023
Mailing Address - Country:US
Mailing Address - Phone:717-877-8811
Mailing Address - Fax:717-732-0178
Practice Address - Street 1:850 WALNUT BOTTOM RD STE 306
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3615
Practice Address - Country:US
Practice Address - Phone:717-877-8811
Practice Address - Fax:717-918-5745
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7472225XH1200X
225XH1200X
PAOC002500L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3571011OtherAETNA HMO
PA50012506OtherCAPITAL BLUE CROSS
PA7600575OtherAETNA PPO
PA76210OtherHEALTH AMERICA COVENTRY H