Individual
STACEY LYNN OMEARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4065 W MAIN ST, BATAVIA, NY 14020-1215
(303) 408-2615
Mailing address
PO BOX 15444, SARASOTA, FL 34277-1444
(303) 408-2615
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA21923
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
01/27/2010
Last updated
01/27/2010
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