Stacey Wallace, OTRL | |
5600 Waldo Ave, Midland, MI 48642-6438 | |
(989) 575-3255 | |
Not Available |
Full Name | Stacey Wallace |
---|---|
Gender | Female |
Speciality | Occupational Therapist |
Location | 5600 Waldo Ave, Midland, Michigan |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1043951957 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225X00000X | Occupational Therapist | 5201011236 (Michigan) | Primary |
Provider Name | Legacy Healthcare Services Inc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1942829064 PECOS PAC ID: 2163339722 Enrollment ID: O20200618000474 |
Mailing Address | Practice Location Address |
---|---|
Stacey Wallace, OTRL 3326 Binscarth Ave, Saginaw, MI 48602-3203 Ph: (989) 327-9967 | Stacey Wallace, OTRL 5600 Waldo Ave, Midland, MI 48642-6438 Ph: (989) 575-3255 |
Tessa M. Wolfe, OTRL Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 32 S Homer Rd, Midland, MI 48640 Phone: 989-492-7766 | |
Kristain Joan Puckett, OTR Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 1525 Ridgewood Dr, Midland, MI 48642 Phone: 989-835-6333 | |
Landon Reed, Occupational Therapist Medicare: Medicare Enrolled Practice Location: 4401 Campus Ridge Dr Ste 1000, Midland, MI 48640 Phone: 989-871-9100 | |
Miss Alyssa Lynn House, MS-OTR/L Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 1525 Ridgewood Dr, Midland, MI 48642 Phone: 989-835-6333 | |
Mr. Charles Matthew Bass, OT Occupational Therapist Medicare: Medicare Enrolled Practice Location: 4421 W Main St, Midland, MI 48640 Phone: 989-832-9026 | |
Mr. Eric David Nolish, OTR/L Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 3615 E Ashman St, Midland, MI 48642 Phone: 989-837-0895 |