Individual
STACIE MICHELLE VAN DAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
421 TOWANDA CIR, DAYTON, OH 45431-2132
(937) 974-5138
Mailing address
421 TOWANDA CIR, DAYTON, OH 45431-2132
(937) 974-5138
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
245809
OR
Other
Enumeration date
10/01/2018
Last updated
10/01/2018
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