Basic Information
| Provider Information | |||||||||
| NPI: | 1548435001 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANNOY | ||||||||
| FirstName: | STACY | ||||||||
| MiddleName: | JOYCE | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220-1 FLAT BRANCH RD | ||||||||
| Address2: | |||||||||
| City: | GATESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279389621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523575235 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 HASTEAD BLVD | ||||||||
| Address2: | |||||||||
| City: | ELIZABETH CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523380137 | ||||||||
| FaxNumber: | 2523384512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2008 | ||||||||
| LastUpdateDate: | 04/25/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 5250 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.