Provider Demographics
NPI:1992884290
Name:SEALSCOTT, STACEY (OTR/L)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:SEALSCOTT
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 1:225 ABRAHAM FLEXNER WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1882
Mailing Address - Country:US
Mailing Address - Phone:502-561-4295
Mailing Address - Fax:
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:FLOOR 6
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1882
Practice Address - Country:US
Practice Address - Phone:502-561-4295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004258225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY03446OtherSTATE LICENSE
GAOT004258OtherSTATE LISC NUMBER
KY0988913Medicare PIN