Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT8447 | FL |
NPI | 1003169020 |
---|---|
Provider Name | Stacy Foust Renz |
First Address | Saint Petersburg, FL 33702-3654 |
Second Address | Saint Petersburg, FL 33702-3654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2012 |
Last Update Date | 22/05/2019 |