Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1537 | AK |
NPI | 1033296405 |
---|---|
Provider Name | Mrs. Stacey Marie Lord |
First Address | Anchorage, AK 99507-2236 |
Second Address | Anchorage, AK 99518-3330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT15371 | (05) | AK |