Individual
MR. JAMES LEE STACEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
1337 HOWE AVE STE 107, SACRAMENTO, CA 95825-3305
(916) 564-5010
Mailing address
1337 HOWE AVE STE 107, SACRAMENTO, CA 95825-3305
(916) 564-5010
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
636
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2592
CALIFORNIA BOARD OF OCCUPATIONAL THERAPY
CA
01
—
636
COTA
TN
Enumeration date
08/01/2012
Last updated
04/08/2014
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